scholarly journals Exploring Leadership, Stress of Conscience, and Person-Centered Care in Nursing Homes

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 181-182
Author(s):  
Annica Backman ◽  
Karin Sjögren ◽  
Hugo Lovheim ◽  
Marie Lindkvist ◽  
David Edvardsson
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Daily Basis ◽  
Care Providers ◽  
Cross Sectional ◽  
Negatively Associated ◽  
Centered Care ◽  
Stress Of Conscience ◽  
The Impact ◽  
The Relationship

Abstract On a daily basis, many care situations contain difficult issues and challenges for care providers. Stress of conscience, such as feelings of guilt, can be experienced by staff when not fulfilling ethical obligations to the residents. Although leadership has been advocated as a key component for staff work perceptions as well as for person-centred care, the impact of nursing home managers’ leadership on levels of stress of conscience among staff and the extent to which person-centred care (PCC) is provided is yet to be explored. Thus, the aim was to explore the relationship between leadership, stress of conscience and PCC as perceived by staff. The study was based on a cross-sectional national survey of 3084 staff and their managers in 189 nursing homes throughout Sweden. Descriptive statistics and regression modelling were used to explore associations. The preliminary results showed that leadership was negatively associated to stress of conscience and positively associated to PCC. PCC were negatively associated to stress of conscience. Additional findings will be presented. This indicates that nursing home managers’ leadership seem to beneficially impact staff work situation in terms of stress of conscience and person-centred care provision.

scholarly journals A QUALITATIVE STUDY OF NURSING HOME STAFF CONCEPTUALIZATION OF EVERYDAY DECISION-MAKING CAPACITY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S700-S700
Author(s):  
Whitney L Mills ◽  
Mark E Kunik ◽  
Lea Kiefer ◽  
Hannah Curren-Vo ◽  
Amy Mochel ◽  
...  
Keyword(s):  
Decision Making ◽  
Nursing Home ◽  
Nursing Homes ◽  
Qualitative Content Analysis ◽  
Daily Basis ◽  
Care Providers ◽  
Nursing Home Staff ◽  
Person Centered Care ◽  
Decision Making Capacity ◽  
Centered Care

Abstract Because nursing homes are both a residence and a treatment setting, care providers are faced with the challenge of balancing resident autonomy and safety on a daily basis. While there are standardized approaches for determining a capacity to make larger decisions such as providing consent for medical procedures, there are virtually no methods for assessing capacity to make everyday decisions (e.g., food choices, smoking, navigating outside the nursing home). While it is easier for staff to prevent residents from making decisions they deem risky, to truly offer person-centered care, it is important to support a resident’s right to make decisions if they have the capacity to do so. Currently, little is known about how nursing home staff conceptualize and determine everyday decision-making capacity and how that information is used in care planning. To understand the current processes and language nursing home staff use when considering a resident’s decision-making capacity, we conducted interviews with 37 staff at two Veterans Affairs (VA) Community Living Centers (VA-operated nursing homes; CLCs). Using qualitative content analysis, we coded the transcribed interviews and identified several overarching themes: autonomy vs. safety, communication (e.g., pathways, with caregivers, with residents), determining capacity (e.g., information gathering, assessment, assumptions, indicators, interdisciplinary team member roles, referrals), interventions (e.g., legal and staff-led), and terminology used. We will describe how the findings from this study can be used to tailor development and adaptation of tools to help nursing home staff assess resident everyday decision-making capacity and to incorporate the results into person-centered care approaches.

scholarly journals Malpractice Environment vs Direct Litigation: What Drives Nursing Home Exit?

2018 ◽  
Vol 55 ◽  
pp. 004695801878799
Author(s):  
R. Tamara Konetzka ◽  
Hari Sharma ◽  
Jeongyoung Park
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Fixed Effects ◽  
Online Survey ◽  
Market Competition ◽  
Consumer Welfare ◽  
Data Sets ◽  
For Profit ◽  
The Impact ◽  
The Relationship

An ongoing concern about medical malpractice litigation is that it may induce provider exit, potentially affecting consumer welfare. The nursing home sector is subject to substantial litigation activity but remains generally understudied in terms of the effects of litigation, due perhaps to a paucity of readily available data. In this article, we estimate the association between litigation and nursing home exit (closure or change in ownership), separating the impact of malpractice environment from direct litigation. We use 2 main data sources for this study: Westlaw’s Adverse Filings database (1997-2005) and Online Survey, Certification and Reporting data sets (1997-2005). We use probit models with state and year fixed effects to examine the relationship between litigation and the probability of nursing home closure or change in ownership with and without adjustment for malpractice environment. We examine the relationship on average and also stratify by profit status, chain membership, and market competition. We find that direct litigation against a nursing home has a nonsignificant effect on the probability of closure or change in ownership within the subsequent 2 years. In contrast, the broader malpractice environment has a significant effect on change in ownership, even for nursing homes that have not been sued, but not on closure. Effects are stronger among for-profit and chain facilities and those in more competitive markets. A high-risk malpractice environment is associated with change of ownership of nursing homes regardless of whether they have been directly sued, indicating that it is too blunt an instrument for weeding out low-quality nursing homes.

scholarly journals The relationship of nursing home price and quality of life

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sarah Raes ◽  
Sophie Vandepitte ◽  
Delphine De Smedt ◽  
Herlinde Wynendaele ◽  
Yannai DeJonghe ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Nursing Homes ◽  
Research Question ◽  
Nursing Home Residents ◽  
Cross Sectional Study ◽  
Ownership Type ◽  
Cross Sectional ◽  
The Relationship

Abstract Background Knowledge about the relationship between the residents’ Quality of Life (QOL) and the nursing home price is currently lacking. Therefore, this study investigates the relationship between 11 dimensions of QOL and nursing homes price in Flemish nursing homes. Methods The data used in this cross-sectional study were collected by the Flemish government from years 2014 to 2017 and originates from 659 Flemish nursing homes. From 2014 to 2016, data on the QOL of 21,756 residents was assessed with the InterRAI instrument. This instrument contains 11 QOL dimensions. Multiple linear regression analyses were conducted to examine the research question. Results The multiple linear regressions indicated that a 10 euro increase in the daily nursing home price is associated with a significant decrease (P <  0.001) of 0.1 in 5 dimensions of QOL (access to services, comfort and environment, food and meals, respect, and safety and security). Hence, our results indicate that the association between price and QOL is very small. When conducting a subgroup analysis based on ownership type, the earlier found results remained only statistically significant for private nursing homes. Conclusion Our findings show that nursing home price is of limited importance with respect to resident QOL. Contrary to popular belief, our study demonstrates a limited negative effect of price on QOL. Further research that includes other indicators of QOL is needed to allow policymakers and nursing home managers to improve nursing home residents’ QOL.

scholarly journals The Relationship of Nursing Home Price and Quality of Life

2020 ◽  
Author(s):  
Sarah Raes ◽  
Sophie Vandepitte ◽  
Delphine De Smedt ◽  
Herlinde Wynendaele ◽  
Yannai DeJonghe ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Nursing Homes ◽  
Research Question ◽  
Nursing Home Residents ◽  
Cross Sectional Study ◽  
Ownership Type ◽  
Cross Sectional ◽  
The Relationship

Abstract Background: Knowledge about the relationship between the residents’ Quality Of Life (QOL) and the nursing home price is currently lacking. Therefore, this study investigates the relationship between 11 dimensions of QOL and nursing homes price in Flemish nursing homes.Methods: The data used in this cross-sectional study were collected by the Flemish government from years 2014 to 2017 and originates from 659 Flemish nursing homes. From 2014 to 2016, data on the QOL of 21,756 residents was assessed with the InterRAI instrument. This instrument contains 11 QOL dimensions. Multiple linear regression analyses were conducted to examine the research question.Results: The multiple linear regressions indicated that a 10 euro increase in the daily nursing home price is associated with a significant decrease (P < 0.001) of 0.1 in 5 dimensions of QOL (access to services, comfort and environment, food and meals, respect, and safety and security). Hence, our results indicate that the association between price and QOL is very small. When conducting a subgroup analysis based on ownership type, the earlier found results remained only statistically significant for private nursing homes.Conclusion: Our findings show that nursing home price is of limited importance with respect to resident QOL. Contrary to popular belief, our study demonstrates a limited negative effect of price on QOL. Further research that includes other indicators of QOL is needed to allow policymakers and nursing home managers to improve nursing home residents’ QOL.

scholarly journals THE IMPACT OF CULTURE CHANGE ON FINANCIAL PERFORMANCE OF HIGH MEDICAID NURSING HOMES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S156-S156
Author(s):  
Justin C Lord ◽  
Ganisher K Davlyatov ◽  
Akbar Ghiasi ◽  
Robert Weech-Maldonado
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Financial Performance ◽  
Culture Change ◽  
Market Competition ◽  
Profit Margin ◽  
Organizational Level ◽  
Poverty Level ◽  
The Impact ◽  
The Relationship

Abstract This study examines the association between culture change artifacts and financial performance among under-resourced nursing homes (70% or higher Medicaid census). Culture change represents a transformational process to become person-centered, through staff and resident empowerment. Cultural artifacts represent the physical evidences that culture change is occurring. In this study, we focus on the workplace (nurse staffing consistent assignments) and leadership (residents engagement) artifacts to assess the relationship between culture change practices and performance. Survey data came from 387 nursing home directors from 2016- 2018, merged with secondary data from LTCFocus, Area Health Resource File, and Medicare Cost Reports. The dependent variable consisted of the total profit margin (%), while the independent variables comprised composite scores for leadership (0-25) and workplace artifacts (0-15). Control variables included organizational-level (ownership, chain affiliation, size, occupancy rate, and Medicare and Medicaid payer mix), and county-level factors (Medicare Advantage penetration, per capita income, educational level, unemployment rate, poverty level and competition). Multivariate regression was used to model the relationship between cultural change artifacts and financial performance. Workplace artifacts in nursing homes were found to be associated with significantly higher profit margin (β = 0.30, p &lt; 0.05), while leadership artifacts were not. Culture change practices aimed at improving nursing staff consistent assignments are associated with better financial performance. Given increasing nursing home market competition and declining resources for high Medicaid nursing homes, facilities with a greater emphasis on workplace culture may be able to perform better financially among these under-resourced facilities.

Statin Intake and All-Cause Mortality among Older Nursing Home Residents

Gerontology ◽  
2021 ◽  
pp. 1-5
Author(s):  
Anton De Spiegeleer ◽  
Jordi Van Migerode ◽  
Antoon Bronselaer ◽  
Evelien Wynendaele ◽  
Milan Peelman ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Older People ◽  
Absolute Risk ◽  
Nursing Home Residents ◽  
Absolute Risk Reduction ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
All Cause Mortality ◽  
The Impact

<b><i>Background:</i></b> Statins are progressively accepted as being associated with reduced mortality. However, few real-world statin studies have been conducted on statin use in older people and especially the most frail, that is, the nursing home residents. <b><i>Objective:</i></b> The aim of this study was to evaluate the impact of statin intake in nursing home residents on all-cause mortality. <b><i>Method:</i></b> This is a cross-sectional study of 1,094 older people residing in 6 nursing homes in Flanders (Belgium) between March 1, 2020 and May 30, 2020. We considered all residents who were taking statins for at least 5 days as statin users. All-cause mortality during the 3 months of data collection was the primary outcome. Propensity score overlap-weighted logistic regression models were applied with age, sex, functional status, diabetes, and cardiac failure/ischemia as potential confounders. <b><i>Results:</i></b> 185 out of 1,094 residents were on statin therapy (17%). The statin intake was associated with decreased all-cause mortality: 4% absolute risk reduction; adjusted odds ratio 0.50; CI 0.31–0.81, <i>p</i> = 0.005. <b><i>Conclusions:</i></b> The statin intake was associated with decreased all-cause mortality in older people residing in nursing homes. More in-depth studies investigating the potential geroprotector effect of statins in this population are needed.

scholarly journals Longitudinal Changes in Leadership and Person-Centered Care Over 5 Years in Swedish Nursing Homes

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 374-374
Author(s):  
Annica Backman ◽  
Karin Sjögren ◽  
Hugo Lövheim ◽  
Marie Lindkvist ◽  
David Edvardsson
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Demographic Variables ◽  
Leadership Characteristics ◽  
Cross Sectional ◽  
Operational Model ◽  
Perceived Leadership ◽  
Centered Care ◽  
Psychosocial Climate

Abstract Nursing home leadership has been described as crucial for person-centred care and psychosocial climate, but longitudinal data are lacking. The significance of manager educational qualifications and operational model of nursing homes for perceived leadership, person-centred care and psychosocial climate also needs further exploration. This study aimed to explore changes in nursing home managers’ leadership, person-centred care and psychosocial climate comparing matched units in a five-year follow-up. Also, to explore changes in leadership characteristics’ and the significance of manager qualifications for perceived leadership, person-centred care and climate. Repeated cross-sectional, valid and reliable, measures of leadership, person-centred care, psychosocial climate and demographic variables were collected from managers and staff n=3605 in 2014 and n=2985 staff in 2019. Descriptive and regression analyses were used. Leadership remained significantly associated to person-centred care in a five-year follow-up, but no changes in strength of associations were seen. Leadership also remained significantly associated to psychosocial climate, with stronger associations at follow-up. Also, certain leadership characteristics significantly increased over time, thus, partly confirms previous findings. It was also shown that a targeted education for managers was significantly associated to person-centred care.

scholarly journals The influence of nursing home managers’ leadership on person-centred care and stress of conscience: A cross-sectional study

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Annica Backman ◽  
Karin Sjögren ◽  
Hugo Lövheim ◽  
Marie Lindkvist ◽  
David Edvardsson
Keyword(s):  
Nursing Home ◽  
Aged Care ◽  
Cross Sectional Study ◽  
Care Practice ◽  
Care Provision ◽  
Cross Sectional ◽  
New Ideas ◽  
Stress Of Conscience ◽  
Giving Feedback ◽  
The Relationship

Abstract Background Leadership and stress are common concepts in nursing, and this study explores empirically the connection between leadership and stress of conscience in the context of aged care practice. Previous literature has shown that when staff are unable to carry out their ethical liabilities towards the residents, feelings of guilt may occur among staff, which may be an expression of stress of conscience. Although leadership has been described as crucial for staff’s work perceptions of stress as well as for person-centred practices, the influence of nursing home managers’ leadership on stress of conscience among staff and person-centred practices is still not fully explored. This study attempts to address that knowledge gap by exploring the relationship between leadership, person-centred care, and stress of conscience. Methods This study was based on a cross-sectional national survey of 2985 staff and their managers in 190 nursing homes throughout Sweden. Descriptive statistics and regression modelling were used to explore associations. Results Leadership was associated with a higher degree of person-centred care and less stress of conscience. A higher degree of person-centred care was also associated with less stress of conscience. The results also showed that leadership as well as person-centred care were individually associated with lower levels of stress of conscience when adjusting for potential confounders. Conclusion Nursing home managers’ leadership was significantly associated with less staff stress of conscience and more person-centred care. This indicates that a leadership most prominently characterised by coaching and giving feedback, relying on staff and handling conflicts constructively, experimenting with new ideas, and controlling work individually can contribute to less staff stress as well as higher degree of person-centred care provision.

scholarly journals COVID-19 and Person-Centered Care: Lessons Learned Through a Statewide Program for Nursing Homes

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 270-271
Author(s):  
Migette Kaup ◽  
Laci Cornelison
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Infection Control ◽  
Pay For Performance ◽  
Control Strategies ◽  
Lessons Learned ◽  
Frail Elders ◽  
Person Centered Care ◽  
Centered Care ◽  
The Impact

Abstract Frail elders in nursing homes are the highest risk group for developing complications of COVID-19. This lead to a response from CMS and state regulators that was heavily focused on protection and safety through segregation and infection control. The purpose of this study was to gather the narrative of this pandemic response and understand the impact on person-centered care and be able to address provider needs in real-time. This qualitative method focused on nursing home providers who are a part of PEAK 2.0, a Medicaid pay-for-performance program in Kansas. Interviews with nursing home staff (n=168) revealed two critical themes of need; mandated responses disregarded elders’ autonomy and self-determination in decision making, and infection control strategies required new approaches to facets of resident care that still maintained dignity. This data, along with COVID-19 guidance were then used to inform feasible resource development and education to maintain PCC practices during the pandemic.

scholarly journals Outbreaks of COVID-19 in Nursing Homes: A Cross-Sectional Survey of 74 Nursing Homes in a French Area

2021 ◽  
Vol 10 (18) ◽  
pp. 4280
Author(s):  
Emilie Piet ◽  
Alexis Maillard ◽  
Franck Olivier Mallaval ◽  
Jean Yves Dusseau ◽  
Murielle Galas-Haddad ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Bivariate Analysis ◽  
Strong Positive Correlation ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Staff Members ◽  
The Relationship ◽  
Univariate Analyses

In this multi-centric cross-sectional survey conducted in nursing homes of the French Alps, from 1 March to 31 May 2020, we analyze the relationship between the occurrence of an outbreak of COVID 19 among residents and staff members. Out of 225 eligible nursing homes, 74 (32.8%) completed the survey. Among 5891 residents, the incidence of confirmed or probable COVID-19 was 8.2% (95CI, 7.5% to 8.9%), and 22 (29.7%) facilities had an outbreak with at least 3 cases. Among the 4652 staff members, the incidence of confirmed or probable COVID-19 was 6.3% (95CI, 5.6% to 7.1%). A strong positive correlation existed between residents and staff members for both numbers of cases (r2 = 0.77, p < 0.001) and the incidence (r2 = 0.76, p < 0.001). In univariate analyses, cases among the staff were the only factor associated with the occurrence of an outbreak among residents (OR = 11.2 (95CI, 2.25 to 53.6)). In bivariate analysis, this relationship was not influenced by any nursing home characteristics, nor the action they implemented to mitigate the COVID-19 crisis. Staff members were, therefore, likely to be a source of contamination and spread of COVID-19 among nursing home residents during the first wave of the pandemic.

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