Suzanne K. Sikma

Types, prevalence, and potential clinical significance of medication administration errors in assisted living.

OBJECTIVES: To describe the types and potential clinical significance of medication administration errors in assisted living (AL).

Self-Directed Care: An Evaluation

This study evaluates self-directed care (SDC), a program introduced in 2000 in Washington State to promote consumer direction in community-based services for persons with disabilities. This report summarizes findings on satisfaction with the program, service quality and consumer safety, instances and outcomes of consumer abuse and neglect, and staffing issues in SDC. Methods included surveys and interviews with participants in SDC and review of existing databases, complaint logs and reports, and departmental field notes. Major findings were no negative outcomes for consumers, improvements in quality of life and quality of care for consumers, high satisfaction, perception of SDC as a valued option, and the challenges of ensuring adequate staffing.

Strategies to promote safe medication administration in assisted living settings

Assisted living (AL) provides lower cost, less institutional environments than skilled nursing facilities, yet less professional oversight, despite the high prevalence of chronic conditions among residents. Unlicensed staff administer large quantities of medications daily, and medication management is one of the three top quality issues in AL, with error rates ranging from 10% to 40%. This qualitative study described AL provider views on medication safety and strategies used to promote safety in medication administration. The sample included 96 participants representing all parties involved in medication administration (i.e., medication aides, administrators, RNs, consulting pharmacists, primary care providers) in 12 AL settings in three states. Core themes were the importance of medication safety, unique contextual factors in AL, and strategies used to promote medication safety. This study has implications for research on interventions to improve medication safety at the individual, facility, and policy levels.

Nurse Delegation in Washington State: A Case Study of Concurrent Policy Implementation and Evaluation:

This case study of an evaluation of a nursing practice change in Washington State community residential settings illustrates issues in concurrent policy evaluation and implementation. The legislative policy changed community health nursing practice for nurses delegating to and supervising assistive personnel caring for older and disabled persons in their homes. Authorizing legislation was a culmination of several years of often contentious public and legislative debate. This article discusses the policy history, environment, and goals; the stakeholders involved in the process; the methodological issues and challenges; and the strategies used to ensure credibility with stakeholders.

Supporting Self-Determination of Older Adults in Community Health Settings: A Curriculum Development Project

This article describes a curriculum development project to strengthen the geriatric component of an RN-to-BSN program through creation of a multidisciplinary curricular framework that supports the self-determination of older adults and promotes best practices in geriatric community health nursing. The project involved integrating multidisciplinary theories with nursing competencies generated from interviews with geriatric community health nurses that subsequently were cross-validated with baccalaureate competencies for geriatric nursing care. The outcome was a theory and practice-based curricular model for teaching geriatric community health nursing used to strengthen the development of geriatric nursing competence of RN-to-BSN students.

Leadership in Nursing Homes: Directors of Nursing Aligning Practice With Regulations

Nursing homes use team nursing, with minimal RN presence, leaving the majority of direct care to licensed practical/vocational nurses (LPNs/LVNs) and unlicensed assistive personnel (UAP), including medication aides. The current article describes challenges faced by nursing home directors of nursing (DONs) leading and managing a team nursing approach, including consideration of scope of practice, delegation and supervision regulations, and related policy implications. A secondary data analysis was performed of qualitative data from a study to develop and test DON guidelines for delegation in nursing home practice. A convenience sample (N = 29) of current or previous DONs and other nursing home leaders with knowledge and expertise in the DON role participated in in-depth, guided interviews. The findings highlight a core concern to nursing licensure policy and regulation: knowledge and practice gaps related to scope of practice and delegation and supervision among DONs, RNs, and LPNs/LVNs, as well as administrators, and the role of nursing leaders in supporting appropriate delegation practices. The findings offer directions for research and practice in addressing challenges in aligning team nursing practices with regulatory standards as well as the related gaps in knowledge among DONs, administrators, and nursing staff. [Journal of Gerontological Nursing, 44(6), 10-14.].