Kathleen Abrahamson

Does Cognitive Impairment Influence Quality of Life among Nursing Home Residents

PURPOSE We investigated the relationship between cognitive status and quality of life (QOL) of Minnesota nursing home (NH) residents and the relationship between conventional or Alzheimers special care unit (SCU) placement and QOL. The study may inform development of dementia-specific quality measures. DESIGN AND METHODS Data for analyses came from face-to-face interviews with a representative sample of 13,130 Minnesota NH residents collected through the 2007 Minnesota NH Resident Quality of Life and Consumer Satisfaction survey. We examined 7 QOL domains: comfort, meaningful activities, privacy, environment, individuality, autonomy, relationships, and a positive mood scale. We applied multilevel models (resident and facility) to examine the relationship between the residents score on each QOL domain and the residents cognitive impairment (CI) level and SCU placement after controlling for covariates, such as activities of daily living dependency, pain, depression or psychiatric diagnosis, and length of stay. RESULTS Residents with more severe CI reported higher QOL in the domains of comfort and environment and lower QOL in activities, individuality, privacy and meaningful relationships, and the mood scale. Residents on SCU reported higher QOL in the meaningful activities, comfort, environment, and autonomy domains but had lower mood scores. IMPLICATIONS Our findings point to QOL domains that show significant variation by CI and thus may be of greatest interest to consumers, providers, advocacy groups, and other stakeholders committed to improving dementia care. Findings are particularly applicable to the development of NH quality indicators that more accurately represent the QOL of NH residents with CI.

Do staff nurse perceptions of nurse leadership behaviors influence staff nurse job satisfaction? The case of a hospital applying for Magnet® designation.

BACKGROUND: Nurse managers leadership behaviors influence the job satisfaction of staff nurses. Transformational leadership is 1 of the 5 components associated with the Magnet Recognition Program®. OBJECTIVE: The aim of this study was to examine the relationship between staff nurse perception of nurse manager leadership behavior and staff nurse job satisfaction in a hospital on the Magnet® journey and the influence of nurse manager leadership style on staff nurse job satisfaction. METHODS: A descriptive, correlational design using a self-report survey with convenience sampling was used for this quantitative research study. Staff nurses completed the Multifactor Leadership Questionnaire 5X Short Form, the Abridged Job Descriptive Index survey, and a demographic questionnaire. Pearson correlations and regression analyses were completed to explore the relationship and influence of nurse manager leadership style on staff nurse job satisfaction. RESULTS: Transformational and transactional leadership styles of nurse managers were positively related to staff nurse overall job satisfaction and satisfaction with opportunity for promotion. Passive-avoidant leadership style of nurse managers was negatively related to staff nurse satisfaction with work, promotion, supervision, and coworker. Satisfaction with nurse manager leadership was a positive influence on overall nurse job satisfaction when separately controlling for the influence of each leadership style. CONCLUSION: Transformational and transactional leadership styles should be taught and encouraged among nurse managers to positively influence the job satisfaction of staff nurses.

Minnesota’s Provider-Initiated Approach Yields Care Quality Gains At Participating Nursing Homes

Minnesotas Performance-Based Incentive Payment Program uses a collaborative, provider-initiated approach to nursing home quality improvement: up-front funding of evidence-based projects selected and designed by participating facilities, with accountable performance targets. During the first 4 rounds of funding (2007-10), 66 projects were launched at 174 facilities. Using a composite quality measure representing multiple dimensions of clinical care, we found that facilities participating during this period exhibited significantly greater gains than did nonparticipating facilities, in both targeted areas and overall quality, and maintained their quality advantage after project completion. Participating and nonparticipating facilities were similar at baseline with respect to quality scores and improvement trends, as well as acuity-adjusted payment, operating costs, and nurse staffing. Although self-selection precludes firm conclusions regarding the programs impacts, early findings indicate that the program shows promise for incentivizing nursing home quality improvement, both in facility-identified areas of concern and overall.

Implementation of a nursing home quality improvement project to reduce resident pain: a qualitative case study.

This article describes the experiences of staff members working within nursing homes that successfully implemented a quality improvement project aimed at reducing resident pain. Interviews were conducted with 24 nursing home employees from within 8 facilities participating in the quality improvement project. Findings were organized using the Consolidated Framework for Implementation Research. Interdisciplinary communication, supportive leadership, training, and nursing assistant participation facilitated implementation. Increased documentation, resistance to change, and difficulty measuring outcomes were perceived challenges.

How Exercise Influences Cognitive Performance When Mild Cognitive Impairment Exists: A Literature Review.

Older adults who present with mild cognitive impairment (MCI) have an increased risk of developing more advanced dementia. However, no pharmacological treatment currently exists to slow the progression of or reverse MCI. The purpose of the current systematic review is to summarize evidence surrounding the impact of exercise interventions on the cognitive performance levels of community-dwelling older adults with MCI. Computerized database and ancestry search strategies located distinct intervention trials between 1990 and 2015. Results indicated that physical exercise may benefit cognitive function among older adults who have MCI, including improvements in global cognition, executive function, memory, attention, and processing speed. Physical exercise may also positively impact the physiology of the aging brain. However, evidence surrounding the characteristics of effective physical exercise interventions in terms of exercise type, intensity, duration, and frequency remains limited.

The Relationship Between Nurse-Reported Safety Culture and the Patient Experience.

OBJECTIVE: The purpose of this study was to better understand the relationship between nurse-reported safety culture and the patient experience in a multistate sample of nurses and patients, matched by hospital unit/service line and timeframe of care delivery. BACKGROUND: Nurses play a key role in the patient experience and patient safety. A strong safety culture may produce positive spillover effects throughout the nurse caregiving experience, resulting in patient perception of a high-quality experience. METHODS: Multivariate mixed-effects regression models were specified using data from a multistate sample of hospital units that administered both the Agency for Healthcare Research and Quality (AHRQ) staff safety culture survey and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction survey over a 12-month period. Survey response variables are measured at the unit (service line) and hospital level. RESULTS: Key variables in the HCAHPS and AHRQ surveys were significantly correlated. Findings highlight the relationship between 3 safety culture domains: teamwork, adequate staffing, and organizational learning on the achievement of a positive patient experience. CONCLUSION: Modifiable aspects of hospital culture can influence the likelihood of achieving high HCAHPS top box percentages in the nursing and global domains, which directly impact hospital reimbursement.

Substance Abuse Policies in Long-Term Care Facilities: A Survey with Implications for Education of Long-Term Care Providers

The aging of the Baby Boom presents long-term care with many new challenges. Among these are the historically high levels of drug use by this cohort. This study surveyed administrators of licensed skilled nursing facilities in the Commonwealth of Kentucky regarding their perception of current drug use by residents, facility policies and procedures currently in place regarding illicit drug use, and their attitudes toward use of illicit drugs by residents. The results of interviews with 40 administrators or their designees revealed that they have experienced little problem with use or abuse of illegal drugs by residents. Fewer than one-third of the facilities had formal policies in place regarding illegal drug use. Only 10% had any experience with requests for medical marijuana, but almost one in five had a policy on the matter and nearly one-third stated they would support medical marijuana use by some of their residents if the matter arose. These authors recommend the following: (a) that the issue of illicit drug use needs to be addressed now before the situation becomes critical, (b) that administrators and staff need to be educated about recreational drug use and appropriate responses to drug abuse, (c) that screening instruments for drug abuse in this population should be developed and implemented, and (d) that policies regarding medical marijuana need to be adopted by all such facilities.