Jeanie Kayser-Jones

Factors Contributing to Dehydration in Nursing Homes: Inadequate Staffing and Lack of Professional Supervision

OBJECTIVE: To investigate the factors that influenced fluid intake among nursing home residents who were not eating well.

The effect of staffing on the quality of care at mealtime

Abstract Inadequate staffing has serious consequences for the nutritional care of nursing home residents. A sufficient number of well-educated and supervised staff members are critical to improving care.

A randomized controlled trial of a specific reminiscence approach to promote the well-being of nursing home residents with dementia

BACKGROUND To date, no firm conclusions can be reached regarding the effectiveness of reminiscence for dementia. Researchers have emphasized that there is an urgent need for more systematic research in the area. OBJECTIVE AND METHOD A single-blinded, parallel-groups (one intervention, one comparison, and one no-intervention group) randomized controlled trial (RCT) was adopted to investigate whether a specific reminiscence program leads to higher levels of psychosocial well-being in nursing home residents with dementia. The intervention adopted a life-story approach, while the comparison group provided friendly discussions to control for any changes in outcome as a result of social contacts and attention. The Social Engagement Scale (SES) and Well-being/Ill-being Scale (WIB) were the outcome measures used. The outcomes of the groups were examined with reference to the baseline (T0), immediately (T1), and six weeks (T2) after intervention. The final sample had 101 subjects (control group: n=30; comparison group: n=35; intervention group: n = 36). Using multivariate analysis with repeated measures, no significant differences in outcome were found between groups at either T1 or T2. Wilcoxon signed rank tests were performed for each group comparing outcomes between T1 and T0, T2 and T1, and T2 and T0. Significant differences were observed in the intervention group when comparing T1 and T0 WIB (p = .014), but not for the other groups. CONCLUSION Although the intervention did not lead to significant differences between the three groups over time, there was a significant improvement in psychosocial well-being for the intervention group.

A Prospective Study of the Use of Liquid Oral Dietary Supplements in Nursing Homes1

OBJECTIVE: To investigate the use of liquid oral dietary supplements among nursing home residents who were eating poorly and losing weight.

Staffing and the mealtime experience of nursing home residents on a Special Care Unit

As part of a study that examined the social, cultural, clinical, and environmental factors that influence eating behavior in nursing homes, the effect of staffing on the mealtime experience of residents in a Special Care Unit (SCU) for dementia patients was investigated. An adequate staff to resident ratio, the presence of a knowledgeable and skillful nursing assistant who was an excellent role model, and sufficient supervision positively affected the experience of residents, making lunchtime a pleasant and nourishing event. In the evening, however; overtaxed and poorly supervised aides resorted to strategies that made dinnertime a hurried, unpleasant experience and put residents under duress. A discussion of how to provide extra help at mealtime, improve the education and training of staff, and enhance supervision at mealtime is presented.

The experience of dying for Chinese nursing home residents: cultural considerations.

Given the increase of cultural diversity of the elderly population in the United States, there is a need for increased sensitivity of culturally diverse residents. Research on the care of terminally ill Chinese elderly individuals in nursing homes is limited. As part of a larger study on end-of-life care in nursing homes, data were obtained on 34 Chinese residents. Data were obtained through participant observation, event analysis, and in-depth interviews with residents and their families, nursing staff, and physicians. The process of providing care was observed from the time residents were identified as terminally ill until their death. The most significant factors influencing the care Chinese residents received were communication barriers, dislike of Western food, and differing cultural beliefs and customs. These findings offer valuable information in helping to develop and implement interventions to improve the terminal care of Chinese elderly individuals in nursing homes.

End-of-life care in assisted living facilities: Perceptions of residents, families, and staffs

Terminally ill residents, their families, and care providers were interviewed and observed in 4 assisted living facilities (ALFs). Families supported the residents’ desires to die “at home,” and dying residents had sustained, caring relationships with some staff. Facilities varied in terms of the services they could provide at the end of life. The staff did not always have sufficient training in care at the end of life, and staffing ratios did not always accommodate the intense care needs of dying people. ALF and hospice staffs did not plan, coordinate, or communicate sufficiently in providing care services. This study suggests that the privacy and autonomy that make ALFs desirable living environments may create challenges when dying residents require increasingly intense monitoring and care.

Risk for low weight in community-dwelling, older adults.

Purpose: The purpose of this study was to describe nutritional risk and low weight in community-dwelling elderly. Method: This cross-sectional exploratory study used in-depth interviews conducted on older adults with a body mass index <24 kg/m2. Depression, mental state, nutrition, and demographic data were measured. Results: These elders (n = 130) were mostly female (55%, n = 71), married, white (84%, n = 109), and had a greater than a high school education. In a multivariate logistic regression analysis, 3 variables were statistically significantly associated with being severely underweight: those who self-reported having an illness or condition that changed the kind and/or amount of food eaten, unintentional weight loss of 10 lb in the last 6 months, and needing assistance with traveling outside the home. Conclusion: Awareness of the high nutritional risk should prompt consideration of early, appropriate assessment and therapy to prevent malnutrition and a declining quality of life.

The effect of role-taking ability on caregiver-resident mealtime interaction

In this qualitative study of mealtime in a nursing home, data were collected on the verbal and nonverbal interaction between certified nursing assistants (CNAs) and completely eating-dependent residents. Although some caregivers were seen to give care in a creative, empathetic manner, others were task-driven and mechanistic. The difference in caregiving was, in part, accounted for by the degree to which individual caregivers were able to engage in role taking, that is, the ability to see the world from the residents perspective. Recommendations for enhancing role-taking ability include (a) asking caregivers to reflect on their own mealtime experiences, (b) encouraging staff to eat with residents, (c) having staff practice feeding one another, and (d) providing role modeling and supervision by professional nursing staff at mealtime.

Defensive work in nursing homes: Accountability gone amok

This paper contrasts conditions in intensive care nurseries and skilled nursing facilities in order to bring out certain features of organizational functioning in nursing homes. Data stem from a study of three American nursing homes which focused on the circumstances influencing decision-making in the evaluation and treatment of acute illness. DEFENSIVE WORK--work that is institution-protective and/or self-protective-emerged as a dominant process. It is demonstrated that the avoidance strategies which constitute defensive work lead to a progression of counterstrategies and foster skewed priorities. Consequences are: an acceptance of substandard care and a diversion of attention from therapeutic work. The relationship of defensive work to the larger question of how the nation handles its sick elderly is examined in the conclusion of the paper. Recommendations are offered for organizational steps that would re-channel the wasted energy that is spent on defensive work toward more productive therapeutic work.