Rural Nursing Homes

Abstract: This mixed methods study used multiple regression analyses to examine the impact of organizational and market characteristics on staffing hours and staffing mix, and qualitative interview to explore the challenges and facilitators of recruiting and retaining qualified staff. Rural nursing homes (NHs) certified by Medicare or Medicaid (N = 161) were sampled from the Online Survey Certification and Reporting system. A subsample (n = 23) was selected purposively for the qualitative analysis. Smaller NHs or government-affiliated homes had more total nursing hours per resident day and more hours of care by certified nursing assistants and RNs than larger and nongovernment-affiliated homes; however, almost 87% of NHs in this study were below the national recommendation for RN hours. Informants voiced challenges related to enough staff, qualified staff, and training staff. Development of nursing resources is critical, especially in rural locales where aging resources may not be well developed. nursing homes | nursing home staff | gerontology | nursing | gerontological nursing

Measuring Nurses’ Impact on Health Care Quality: Progress, Challenges, and Future Directions

Background: Quality measurement is central in efforts to improve health care delivery and financing. The Interdisciplinary Nursing Quality Research Initiative supported interdisciplinary research teams to address gaps in measuring the contributions of nursing to quality care. Objective: To summarize the research of 4 interdisciplinary teams funded by The Interdisciplinary Nursing Quality Research Initiative and reflect on challenges and future directions to improving quality measurement. Methods: Each team summarized their work including the targeted gap in measurement, the methods used, key results, and next steps. The authors discussed key challenges and recommended future directions. Results: These exemplar projects addressed cross-cutting issues related to quality; developed measures of patient experience; tested new ways to model the important relationships between structure, process, and outcome; measured care across the continuum; focused on positive aspects of care; examined the relationship of nursing care with outcomes; and measured both nursing and interdisciplinary care. Discussion: Challenges include: measuring care delivery from multiple perspectives; determining the dose of care delivered; and measuring the entire care process. Meaningful measures that are simple, feasible, affordable, and integrated into the care delivery system and electronic health record are needed. Advances in health information systems create opportunities to advance quality measurement in innovative ways. Conclusions: These findings and products add to the robust set of measures needed to measure nurses’ contributions to the care of hospitalized patients. The implementation of these projects has been rich with lessons about the ongoing challenges related to quality measurement

Confirmatory Factor Analysis of the Pain Care Quality Surveys (Pain CQ © )

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98233/1/hesr12014-sup-0001-Author_matrix.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/98233/2/hesr12014.pd

PhD

dissertationThis sequential mixed methods study examined factors associated with quality care and financial viability of rural nursing homes in the Mountain West. Rural nursing homes were sampled from the Online Survey Certification and Reporting system and Skilled Nursing Facility cost report databases, resulting in 161 cases. Financial data were not available on all nursing homes, which decreased the sample to 74. Qualitative interviews were conducted with a subsample of Administrators and Directors of Nursing (n = 30) from 23 nursing homes. Rural Mountain West nursing homes were smaller, and had lower occupancy rages, and more government/country affiliated homes compared to nursing homes nationwide. There were differences in facility size, Medicare occupancy, and the presence of Alzheimer's beds on location suggesting that isolated areas lack the demand for services or the resources necessary to provide specialized care. Forty-one percent of nursing homes changed ownership. Nursing homes did not vary in health deficiencies or staffing hours or mix. The median profit margin for rural nursing homes (N = 74) was 4.73; but 35% had a negative margin. Higher Medicaid utilization was associated with higher weighted deficiency scores implying lower quality. Those providing better quality, indicated by staffing levels were smaller or government/county affiliated. Medicare occupancy and nursing home size were key predictors of financial viability (R2 = .26,F (4, 73)=6.04,p < .001). On average, Administrators and Directors of Nursing had been in their leadership positions slightly over 5 years. Competition for staff was reported as a common problem. Contract service challenges were related to transporting residents, sometimes hundreds of miles for services. Nursing homes that had more progressive continuing education programs showed higher quality care. However, modern approaches to monitor and improve quality, such as total quality management did not exist. Quality in rural nursing homes is precarious evidenced by low profit margins, ownership changes, and few specialized services. Data from this study illustrated that characteristics of quality and profitability were mixed, at times contrasting, and sometimes differing from expected. Results suggest that when needing to obtain quality nursing home care some older adults in rural communities remain underserved

Psychometric evaluation of the Pittsburgh sleep quality index in cancer patients

Abstract: This report summarizes findings related to the psychometric properties (internal consistency and construct validity) of the Pittsburgh Sleep Quality Index (PSQI) and discusses issues related to its use based on data from two clinical studies with diverse samples of cancer patients. Subjects completed a questionnaire that included the PSQI, the Schwartz Cancer Fatigue Scale, and specific demographic, disease, and treatment variables. There were complete data on 170 (of 214) cases in Study 1 and 249 (of 259) cases in Study 2. The Cronbach&apos;s alpha for the Global Sleep Quality scale was 0.81 in Study 1 and 0.77 in Study 2. A comparison of Global Sleep Quality in two contrasting groups with low and high fatigue yielded statistically significant differences in both samples. Psychometric evaluation supports its internal consistency reliability and construct validity. However, the scoring is rather cumbersome and raises questions regarding level of measurement and appropriate analysis techniques