Janet P. Specht

Issues in conducting research in nursing homes

Anticipation of increased numbers of older persons throughout the coming decades who will require care and assistance with chronic illnesses and functional deficits has correspondingly increased awareness of the need for nursing research to support best geriatric nursing practices. Although badly needed, research in nursing homes presents challenges. This article discusses issues and challenges of ethically acceptable and rigorous research in nursing homes that are related to the dependency and institutionalization of older persons and to setting, staff, and resident characteristics. Strategies for easing the challenges of nursing research in nursing homes are offered.

Nursing Home Staffing and Training Recommendations for Promoting Older Adults’ Quality of Care and Life: Part 1. Deficits in the Quality of Care Due to Understaffing and Undertraining

Caught between the inability or unwillingness of nursing home corporations and owners to redistribute revenue and the reluctance of federal and state agencies to increase payments to nursing homes, the nations most vulnerable older adults are not receiving the care they deserve. Widespread recognition of substandard care and quality of life of older adults in nursing homes has existed for decades. In addition, there is substantial evidence that poor quality of care is related to inadequate numbers and training of nursing staff. Still, policy makers and nursing home owners have failed to take needed action. In the first article of this two-part series, major deficits in the care of older adult nursing home residents are reviewed, and research documenting the relationship between nursing home staffing and the quality of care and life of residents is summarized.

Who's the boss? Family/staff partnership in care of persons with dementia

This article provides an overview of family involvement in care intervention and its implementation with African American and Caucasian family members of persons with dementia in nursing home settings.

Nursing home staffing and training recommendations for promoting older adults' quality of care and life: Part 2. Increasing nurse staffing and training

In the second article of this two-part series, research supporting the need for more RNs and assisting staff (licensed practical nurses [LPNs] and certified nursing assistants [CNAs]) with gerontological nursing training in nursing homes is reviewed. Using the literature, time studies, the judgments of experts, and the expected quality and quantity of care older adults should rightfully receive, recommended standards are set forth for RN and assisting staff hours per resident day, their training, and compensation. Leadership training is recommended for RNs and increased gerontological nursing training is recommended for RNs and assisting staff. Finally, to address the shortage of RNs with gerontological nursing and leadership training in nursing homes, a program to prepare RNs as geriatric nursing long-term care specialists is proposed.

Community Service Issues before Nursing Home Placement of Persons with Dementia

Family caregivers ofpersons with dementia (N = 38) who placed their relative in a nursing home while participating in a longitudinal study were surveyed about their experiences with community services (adult day care, in-home services, and physician home visits). One third (34%) of the sample reported that at least one service issue (affordability, eligibility, access, or service quality) had a strong influence on the nursing home placement, whereas 40% reported that the availability of at least one additional service would have delayed the nursing home placement of their relative. Caregivers who were employed reported higher levels of unmet service needs. The results of this study support the existence of a group of dementia caregivers with a high need for and willingness to use community service interventions in the preinstitu-tional period.

The Relationship Between RN Job Satisfaction and Accountability

The purpose of this descriptive correlational secondary data analysis is to describe the relationship between job satisfaction and accountability among registered nurses with clinical responsibilities employed by a rural health care network in the Midwest. The response rate from the primary study is 39%, with 337 RN respondents. The sample for this secondary analysis is 299. The instruments used to measure accountability and job satisfaction are the Specht and Ramler Accountability Index—Individual Referent and the McCloskey—Mueller Satisfaction Scale (MMSS). The results indicate that accountability is perceived to be relatively high and job satisfaction is moderate. Accountability and job satisfaction are significantly correlated at a moderate level. The correlations between the subscales of the MMSS and accountability are all statistically significant but low. The subscales with the highest correlations (e.g., control and responsibility, praise and recognition, professional opportunities, scheduling) provide direction for nurse administrators about important target areas for improvement.

Special care units for people with Alzheimer's disease. Only for the privileged few?

The number of Special Care Units (SCUs) for people with Alzheimers disease (AD) in nursing homes have increased dramatically in the past 10 years. Despite the rapid increase in number of SCUs and the concern that most SCUs report higher costs than traditional nursing home units where residents with AD are integrated with cognitively intact residents, the evaluation of costs has been largely unsystematic and noncomparative. Studies are urgently needed to assess comparative costs so that administrators and policy makers can make informed decisions. This article reviews studies that examine the costs of care in SCUs and presents cost-related data comparing the outcomes of care for residents with AD on a SCU and on traditional units in one long-term care setting.

Everyday Excellence: A Framework for Professional Nursing Practice in Long-Term Care

RNs make measurable contributions to the health and wellness of individuals living in nursing homes. However, most nursing homes do not employ adequate numbers of professional nurses with specialized training in the nursing care of older adults to positively affect resident outcomes. As a result, many people never receive excellent geriatric nursing while living in a long-term care facility. Nurses have introduced various professional practice models into health care institutions as tools for leading nursing practice, improving client outcomes, and achieving organizational goals. Problematically, few professional practice models have been implemented in nursing homes. This article introduces an evidence-based framework for professional nursing practice in long-term care. The Everyday Excellence framework is based on eight guiding principles: Valuing, Envisioning, Peopling, Securing, Learning, Empowering, Leading, and Advancing Excellence. Future research will evaluate the usefulness of this framework for professional nursing practice.

Review of exemplar programs for adults with early-stage Alzheimer's disease

In response to the need to develop evidence-based best practices interventions and services for individuals in the early stages of Alzheimers disease (AD), the authors conducted an interdisciplinary literature review of exemplar programs, defined as those including multimodal or unimodal interventions; shown to be appropriate for individuals in the early stages of AD; demonstrating promise to support, maintain, and improve independent functioning; and shown to have positive effects for a variety of outcomes, including quality of life. This article examines evidence from five kinds of programs: (a) multimodal interventions, (b) programs developed by the Southwest Florida Interdisciplinary Center for Positive Aging, (c) sleep enhancement interventions, (d) managed care programs, and (e) technology-based interventions. Evidence from the review suggests that a number of programs can support functioning and improve quality of life for adults living with the early stages of memory loss. The article concludes with recommendations to advance a national research agenda in this area.

The Young Gerontological Nurse Clinician Program: an innovative geropsychiatric nursing recruitment strategy.

Historically, graduate nurses are not attracted to older adults or geriatric care. Innovative strategies, such as the Young Gerontological Nurse Clinician Program (YGNCP) initiated by the John A. Hartford Center for Geriatric Nursing Excellence at the University of Iowa, are needed to promote geriatric nursing as a challenging and rewarding practice focus. The YGNCP, which provides early, positive, self-directed experiences for nursing students under the direction and supervision of faculty and expert clinical mentors, shows excellent potential for recruiting nurses to clinical and leadership positions in geriatric and geropsychiatric care.