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Nursing home research: the first International Association of Gerontology and Geriatrics (IAGG) research conference.

The International Association of Gerontology and Geriatrics held its first conference on nursing home research in St Louis, MO, in November 2013. This article provides a summary of the presentations.

Swiss Nursing Homes Human Resources Project (SHURP): protocol of an observational study

AIM To explore the relationships among various nursing homes characteristics including work environment, careworker outcomes and resident outcomes in Swiss nursing homes. BACKGROUND In Switzerland, a growing number of older people live in nursing homes. Although research has addressed the issue of quality of nursing care in such facilities, few have integrated a range of interrelated factors that may influence the quality and safety of residential care. The Swiss Nursing Homes Human Resources Project will comprehensively assess key organizational factors, their interrelationships and the associations between these factors and careworker and resident outcomes. DESIGN Cross-sectional design. METHODS Three-year multi-centre study (2011-2013) including a representative sample of approximately 160 nursing homes across the three language regions in Switzerland. Survey data will come from approximately 6000 careworkers and 160 administrators. Survey questionnaires will include variables on organizational facility characteristics and resident outcomes, careworker socio-demographic and professional characteristics, the quality of their work environments, resident safety climates and careworker outcomes. Appropriate descriptive and comparative analysis will be used and multivariate and multilevel analyses will be applied to examine the relationships among the various factors including quality of the work environment, safety climate, work stressors, rationing of care, workload, careworker and resident characteristics, as well as resident and careworker outcomes. DISCUSSION The study results will contribute to a comprehensive understanding of the interrelationships between key organizational factors and resident/careworker outcomes and will also support planning and conducting interventions to improve quality of care concerning organizational factors affecting careworkers in daily practice.

The relationship of staffing and work environment with implicit rationing of nursing care in Swiss nursing homes – A cross-sectional study

BACKGROUND Implicit rationing of nursing care refers to the withdrawal of or failure to carry out necessary nursing care activities due to lack of resources, in the literature also described as missed care, omitted care, or nursing care left undone. Under time constraints, nurses give priority to activities related to vital medical needs and the safety of the patient, leaving out documentation, rehabilitation, or emotional support of patients. In nursing homes, little is known about the occurrence of implicit rationing of nursing care and possible contributing factors. OBJECTIVES The purpose of this study was (1) to describe levels and patterns of self-reported implicit rationing of nursing care in Swiss nursing homes and (2) to explore the relationship between staffing level, turnover, and work environment factors and implicit rationing of nursing care. DESIGN Cross-sectional, multi-center sub-study of the Swiss Nursing Home Human Resources Project (SHURP). SETTINGS Nursing homes from all three language regions of Switzerland. PARTICIPANTS A random selection of 156 facilities with 402 units and 4307 direct care workers from all educational levels (including 25% registered nurses). METHODS We utilized data from established scales to measure implicit rationing of nursing care (Basel Extent of Rationing of Nursing Care), perceptions of leadership ability and staffing resources (Practice Environment Scale of the Nursing Work Index), teamwork and safety climate (Safety Attitudes Questionnaire), and work stressors (Health Professions Stress Inventory). Staffing level and turnover at the unit level were measured with self-developed questions. Multilevel linear regression models were used to explore the proposed relationships. RESULTS Implicit rationing of nursing care does not occur frequently in Swiss nursing homes. Care workers ration support in activities of daily living, such as eating, drinking, elimination and mobilization less often than documentation of care and the social care of nursing homes residents. Statistically significant factors related to implicit rationing of care were the perception of lower staffing resources, teamwork and safety climate, and higher work stressors. Unit staffing and turnover levels were not related to rationing activities. CONCLUSIONS Improving teamwork and reducing work stressors could possibly lead to less implicit rationing of nursing care. Further research on the relationship of implicit rationing of nursing care and resident and care worker outcomes in nursing homes is requested.

Are Staffing, Work Environment, Work Stressors, and Rationing of Care Related to Care Workers' Perception of Quality of Care? A Cross-Sectional Study.

OBJECTIVES To describe care worker-reported quality of care and to examine its relationship with staffing variables, work environment, work stressors, and implicit rationing of nursing care. DESIGN Cross-sectional study. SETTING National, randomly selected sample of Swiss nursing homes, stratified according to language region and size. PARTICIPANTS A total of 4311 care workers of all educational backgrounds (registered nurses, licensed practical nurses, nurse aides) from 402 units in 155 nursing homes completed a survey between May 2012 and April 2013. MEASUREMENTS Care worker-reported quality of care was measured with a single item; predictors were assessed with established instruments (eg, Practice Environment Scale-Nurse Working Index) adapted for nursing home use. A multilevel logistic regression model was applied to assess predictors for quality of care. RESULTS Overall, 7% of care workers rated the quality of care provided as rather low or very low. Important factors related to better quality of care were higher teamwork and safety climate (odds ratio [OR] 6.19, 95% confidence interval [CI] 4.36-8.79); better staffing and resources adequacy (OR 2.94, 95% CI 2.08-4.15); less stress due to workload (OR 0.71, 95% CI 0.55-0.93); less implicit rationing of caring, rehabilitation, and monitoring (OR 0.34, 95% CI 0.24-0.49); and less rationing of social care (OR 0.80, 95% CI 0.69-0.92). Neither leadership nor staffing levels, staff mix, or turnover was significantly related to quality of care. CONCLUSIONS Work environment factors and organizational processes are vital to provide high quality of care. The improvement of work environment, support in handling work stressors, and reduction of rationing of nursing care might be intervention points to promote high quality of care in nursing homes.

Factors associated with high job satisfaction among care workers in Swiss nursing homes – a cross sectional survey study

BackgroundWhile the relationship between nurses’ job satisfaction and their work in hospital environments is well known, it remains unclear, which factors are most influential in the nursing home setting. The purpose of this study was to describe job satisfaction among care workers in Swiss nursing homes and to examine its associations with work environment factors, work stressors, and health issues.MethodsThis cross-sectional study used data from a representative national sample of 162 Swiss nursing homes including 4,145 care workers from all educational levels (registered nurses, licensed practical nurses, nursing assistants and aides). Care worker-reported job satisfaction was measured with a single item. Explanatory variables were assessed with established scales, as e.g. the Practice Environment Scale – Nursing Work Index. Generalized Estimating Equation (GEE) models were used to examine factors related to job satisfaction.ResultsOverall, 36.2 % of respondents reported high satisfaction with their workplace, while another 50.4 % were rather satisfied. Factors significantly associated with high job satisfaction were supportive leadership (OR = 3.76), better teamwork and resident safety climate (OR = 2.60), a resonant nursing home administrator (OR = 2.30), adequate staffing resources (OR = 1.40), fewer workplace conflicts (OR = .61), less sense of depletion after work (OR = .88), and fewer physical health problems (OR = .91).ConclusionsThe quality of nursing home leadership–at both the unit supervisor and the executive administrator level–was strongly associated with care workers’ job satisfaction. Therefore, recruitment strategies addressing specific profiles for nursing home leaders are needed, followed by ongoing leadership training. Future studies should examine the effects of interventions designed to improve nursing home leadership and work environments on outcomes both for care staff and for residents.

Factors Associated With Care Workers’ Intention to Leave Employment in Nursing Homes: A Secondary Data Analysis of the Swiss Nursing Homes Human Resources Project:

The emerging care personnel shortage in Swiss nursing homes is aggravated by high turnover rates. As intention to leave is a predictor of turnover, awareness of its associated factors is essential. This study applied a secondary data analysis to evaluate the prevalence and variability of 3,984 nursing home care workers’ intention to leave. Work environment factors and care worker outcomes were tested via multiple regression analysis. Although 56% of care workers reported intention to leave, prevalences varied widely between facilities. Overall, intention to leave showed strong inverse relationships with supportive leadership and affective organizational commitment and weaker positive relationships with stress due to workload, emotional exhaustion, and care worker health problems. The strong direct relationship of nursing home care workers’ intention to leave with affective organizational commitment and perceptions of leadership quality suggest that multilevel interventions to improve these factors might reduce intention to leave.

Ordnungspolitische Ansätze zur Steuerung der Versorgungsqualität in der stationären Langzeitpflege in den USA und der Schweiz

Um die Moglichkeiten der Gesundheitspolitik zur Steuerung der Qualitat in der stationaren Langzeitpflege auszuloten, lohnt es sich, die verschiedenen Strategien im internationalen Vergleich anzuschauen. Fur einen solchen Vergleich ist es notwendig, sich mogliche Wirkmechanismen zur Entwicklung von Qualitat im Langzeitpflegebereich zu vergegenwartigen. Diese werden dann anhand von Beispielen aus den USA und der Schweiz erlautert.

Pain in Critically Ill Older Patients

Pain is a common symptom in patients treated in an intensive care unit (ICU) and can be particularly distressing for older patients. Pain is reported by more than half of the patients treated in an ICU, and up to 75% of all medical and surgical ICU patients report the intensity of their pain as moderate to severe. Extrinsic factors such as medical and nursing treatments, or intrinsic factors such as underlying diseases, are important causes of pain. These factors are often very invasive. This chapter, which focuses on pain in critically ill older patients, shows that treating pain requires an interdisciplinary collaboration, including nurses, physicians, and the other healthcare professionals that are involved in treating patients in the ICU. The entire organization or institution must ensure the establishment of interdisciplinary pain management in order to treat pain adequately. The literature recommends using a numerical rating scale for self-assessment of pain, or a behavioral assessment scale for patients who are unable to express themselves verbally. Patient-oriented, individual treatment goals in terms of pain and analgesia management are shown to be effective in reducing pain. Pharmacological and non-pharmacological treatments help older patients reduce their pain.

A theory-based hybrid II implementation intervention to improve pain management in Swiss nursing homes: A mixed-methods study protocol

AIM To present a protocol for evaluating an implementation intervention to improve pain management in nursing homes by addressing behaviour change of the care workers. BACKGROUND Pain management in nursing homes often is inadequate despite the availability of evidence-based pain management guidelines. Barriers to pain management in nursing homes occur on several levels including lack of knowledge and negative beliefs towards pain of care workers. A comprehensive approach incorporating contextual and behavioural factors is needed to sustainably improve pain management practice. DESIGN A hybrid type II effectiveness-implementation design comprising an incomplete non-randomized stepped-wedge design and concurrent focus groups is proposed. METHODS A convenience sample of six nursing homes will be included. Implementation of a facility pain management policy will be facilitated by introduction of a facility pain champion and training of all care workers in pain assessment and management. Quantitative outcomes assessed at baseline, after 3 and 6 months include self-efficacy in pain management and attitudes to pain of care workers and functional interference from pain and pain intensity in residents. Feasibility and acceptability of the intervention and implementation strategies and potential barriers to implementation will be explored in focus groups and interviews. (Protocol approved in October 2017). CONCLUSION The proposed intervention implementation has been developed in a participatory approach involving relevant stakeholders. To further improve the contextual fit, development of implementation strategies was guided by the consolidated framework of implementation research. Findings of this research are expected to inform adaptions to the implementation of the intervention. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT03471390.

Pflegegeleitete Versorgungsmodelle in der Langzeitpflege

Die Starkung der interprofessionellen Zusammenarbeit hat eine hohe Prioritat im Schweizer Gesundheitswesen.