Strengthening Resident, Proxy, and Staff Engagement in Injury Prevention in Skilled Nursing Facilities

2021 ◽  
Author(s):  
Tingzhong Michelle Xue ◽  
Cathleen S Colón-Emeric ◽  
Laurie Herndon ◽  
Emily J Hecker ◽  
Sarah D Berry ◽  
...  
Keyword(s):  
Injury Prevention ◽  
Skilled Nursing Facility ◽  
Interdisciplinary Teams ◽  
Nursing Assistants ◽  
Time Constraints ◽  
Active Listening ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Open Communication ◽  
Skilled Nursing

Abstract Background and Objectives Engaging residents, their proxies, and skilled nursing facility (SNF) staff through effective communication has potential for improving fall-related injury prevention. The purpose of this study was to understand how multiple stakeholders develop and communicate fall-related injury prevention plans to enhance sustained implementation. Research Design and Methods Descriptive qualitative study using framework analysis applied to open-ended semi-structured interviews (n=28) regarding experiences of communication regarding fall-related injury prevention, guided by the Patient and Family Engaged Care framework. Participants included residents at high risk of injury and their proxies, nursing assistants, nurses, and a nurse practitioner from three SNFs in the Eastern U.S. (Massachusetts and North Carolina). Results Interdisciplinary teams were viewed as essential for injury prevention. However, the roles of the interdisciplinary team members were sometimes unclear. Communication structures were often hierarchical, which reduced engagement of nursing assistants and frustrated proxies. Practices that enhanced engagement included knowing the residents, active listening skills, and use of strategies for respecting autonomy. Engagement was inhibited by time constraints, lack of proactive communication among staff, and by challenges eliciting the perspectives of residents with dementia. Resident barriers included desire for autonomy, strong preferences, and language differences. Discussion and Implications Strengthening team meeting processes and cultivating open communication and collaboration could facilitate staff, resident, and proxy engagement in injury prevention planning and implementation. Skill building and targeting resources to improve communication can address barriers related to staff practices, resident characteristics, and time constraints.

scholarly journals Cognitive Biases Influence Decision-Making Regarding Postacute Care in a Skilled Nursing Facility

2019 ◽  
Vol 15 (01) ◽  
pp. 22-27 ◽  
Author(s):  
Robert E Burke ◽  
Chelsea Leonard ◽  
Marcie Lee ◽  
Roman Ayele ◽  
Ethan Cumbler ◽  
...  
Keyword(s):  
Decision Making ◽  
Cognitive Biases ◽  
Skilled Nursing Facility ◽  
Secondary Analysis ◽  
The United States ◽  
Halo Effect ◽  
Nursing Facilities ◽  
Framework Analysis ◽  
Skilled Nursing ◽  
Postacute Care

BACKGROUND: Decisions about postacute care are increasingly important as the United States population ages, its use becomes increasingly common, and payment reforms target postacute care. However, little is known about how to improve these decisions. OBJECTIVE: To understand whether cognitive biases play an important role in patient and clinician decision-making regarding postacute care in skilled nursing facilities (SNFs) and identify the most impactful biases. DESIGN: Secondary analysis of 105 semistructured interviews with patients, caregivers, and clinicians. SETTING: Three hospitals and three SNFs in a single metropolitan area. PATIENTS: Adults over age 65 discharged to SNFs after hospitalization as well as patients, caregivers, and multidisciplinary frontline clinicians in both hospital and SNF settings. MEASUREMENTS: We identified potential cognitive biases from prior systematic and narrative reviews and conducted a team-based framework analysis of interview transcripts to identify potential biases. RESULTS: Authority bias/halo effect and framing bias were the most prevalent and seemed the most impactful, while default/status quo bias and anchoring bias were also present in decision-making about SNFs. CONCLUSIONS: Cognitive biases play an important role in decision-making about postacute care in SNFs. The combination of authority bias/halo effect and framing bias may synergistically increase the likelihood of patients accepting SNFs for postacute care. As postacute care undergoes a transformation spurred by payment reforms, it is increasingly important to ensure that patients understand their choices at hospital discharge and can make high-quality decisions consistent with their goals.

scholarly journals Person-Centered Healthcare Practice in a Pandemic Context: An Exploration of People's Experience of Seeking Healthcare Support

2021 ◽  
Vol 2 ◽  
Author(s):  
Eleanor Curnow ◽  
Vaibhav Tyagi ◽  
Lisa Salisbury ◽  
Kim Stuart ◽  
Barbara Melville-Jóhannesson ◽  
...  
Keyword(s):  
Problem Solving ◽  
Health Professionals ◽  
Online Survey ◽  
Collaborative Problem Solving ◽  
Active Listening ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Person Centered Care ◽  
Centered Care ◽  
Novel Coronavirus

Background: The recent COVID-19 pandemic increased pressure upon healthcare resources resulting in compromised health services. Enforced national lockdown led to people being unable to access essential services in addition to limiting contact with social support networks. The novel coronavirus, and subsequent condition known as long covid were not well-understood and clinicians were not supported by existing guidelines or pathways. Our study explored people's experiences of healthcare during this period with a person-centered “lens.”Methods: Ninety-seven people participated in our online survey about their experiences of the pandemic, particularly while socially isolated and their experiences of healthcare. Following completion of the survey, 11 of these participants agreed to further semi-structured interviews to explore this further in their own words. Interview conversations were transcribed, checked; together with the responses to open questions in the survey. The data were then analyzed thematically by members of the research team. We conducted framework analysis from a post-positivist perspective, using the Person-centered Practice Framework to explore participants' experiences.Results: There were few examples of people describing person-centered care. People experienced barriers to accessing support, and negative experiences of care that represented complexities enacting person-centered care at each level of the framework (processes, practice environment, prerequisites, and macro context). These barriers were influenced greatly by the pandemic, for example, with health professionals being harder to access. Some experiences related to the ways in which health professionals responded to the context, for example, positive examples included active listening, recognition of people's experiences, seeking to find out more, and engaging in collaborative problem-solving.Discussion: People want to feel heard, supported to navigate healthcare systems, source trustworthy information, find appropriate services, and collaborate in learning and problem-solving with healthcare professionals. There have been enormous challenges to the provision of healthcare throughout the pandemic. Moving forward is crucial with emphasis on overcoming barriers to person-centered healthcare. This should focus on steps now and also in planning for the possibility of further rapid changes in the demand for and provision of healthcare.

Abstract NS15: A Better Understanding of Readmission After Stroke by Including Stroke Survivor and Caregiver Perspectives

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Carole L White ◽  
Tracy L Brady ◽  
Laura L Saucedo ◽  
Deb Motz ◽  
Johanna A Sharp ◽  
...  
Keyword(s):  
Cultural Context ◽  
Recurrent Stroke ◽  
Qualitative Interviews ◽  
Medication Management ◽  
Skilled Nursing Facility ◽  
Stroke Care ◽  
Stroke Survivor ◽  
Structured Interviews ◽  
Skilled Nursing ◽  
Swallowing Problems

Background: At least 30% of stroke survivors (SSs) are readmitted in the first year after stroke. By identifying factors that lead to readmission, we can develop meaningful quality indicators for post-stroke care that target ways to improve health and support the SSs ability to manage at home. Objectives were to: i) estimate readmission rate in a cohort of older SSs at 1 and 6 months after stroke, ii) identify reasons for readmission, and iii) describe the experience of readmission from the perspective of the SS and family caregiver (CG). Methods: This mixed-methods study was undertaken utilizing electronic medical records to track readmissions and qualitative interviews were conducted with SSs and CGs. Older adults (≥ 60 years) with stroke admitted to two hospital systems were enrolled in the cohort and followed for 6 months to capture readmissions. A sample of SSs and CGs were interviewed following readmission to gain their perspective related to discharge after stroke and subsequent readmission. Results: Of the 310 included in the cohort (mean age 76 years, SD 9.8), 10% died prior to discharge. Within one month 10% were readmitted and 25% within 6 months. The main reasons for readmission were recurrent stroke/TIA (19%), pneumonia and urinary tract infection (19%), swallowing problems and dehydration (9%), and cardiac causes (7%). Discharge to a skilled nursing facility (p=.007) and higher Rankin score on discharge (p=.002) were associated with readmission. Semi-structured interviews conducted with 20 SSs and CGs revealed the following themes related to discharge and readmission: discharge preparation that includes their social and cultural context; need for anticipatory guidance on what to expect when home; support for self-management in the community; knowing when to request help; follow-up in the community that could lead to early identification of problems; complexity of medication management; and importance of social support. Conclusions: The perspective of the SS and CG is critical in identifying potential avenues for intervention, aimed at reducing preventable readmissions. Interventions aimed at the transition between hospital and skilled nursing facilities may reduce readmissions.

Malpractice & Negligence: Cal. Supreme Court Clarifies Negligence Provisions under State’s Elder Abuse Act

1999 ◽  
Vol 27 (2) ◽  
pp. 203-203
Author(s):  
Kendra Carlson
Keyword(s):  
Health Care ◽  
Supreme Court ◽  
Health Care Providers ◽  
Elder Abuse ◽  
Skilled Nursing Facility ◽  
Pressure Sores ◽  
Care Providers ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
The Supreme Court

The Supreme Court of California held, in Delaney v. Baker, 82 Cal. Rptr. 2d 610 (1999), that the heightened remedies available under the Elder Abuse Act (Act), Cal. Welf. & Inst. Code, §§ 15657,15657.2 (West 1998), apply to health care providers who engage in reckless neglect of an elder adult. The court interpreted two sections of the Act: (1) section 15657, which provides for enhanced remedies for reckless neglect; and (2) section 15657.2, which limits recovery for actions based on “professional negligence.” The court held that reckless neglect is distinct from professional negligence and therefore the restrictions on remedies against health care providers for professional negligence are inapplicable.Kay Delaney sued Meadowood, a skilled nursing facility (SNF), after a resident, her mother, died. Evidence at trial indicated that Rose Wallien, the decedent, was left lying in her own urine and feces for extended periods of time and had stage I11 and IV pressure sores on her ankles, feet, and buttocks at the time of her death.

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