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Madubata, Juliet Iheoma. "The Influence of Nursing Home Administrator Turnover on Resident Quality of Life." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/325.
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By 2040, 79.7 million older adults will live in the US, and nearly 40% will need nursing home services that are primarily funded by Medicare and Medicaid. Researchers have underscored the importance of leadership in quality healthcare care delivery, suggesting that nursing home administrator turnover could influence resident quality of life, causing ill-health for the residents and preventable medical costs for taxpayers. In spite of the suggested association, little research has specifically examined the role of administrator turnover on resident quality of life. As such, the purpose and central research questions of this case study were designed specifically to address the relationship between nursing home administrator turnover and resident quality of life. The Donabedian health services quality model was the framework for the study. Data were collected from 14 nursing homes, and included semistructured interview data with 7 nursing home administrators, and a review of other documents related to quality of care including site visit reports and surveys. An iterative process of coding and constant comparison was used to identify themes and categories from the data. The findings indicate that turnover likely caused an adverse impact on the nursing home overall, which was expected. The study also determined, however, that high turnover itself was not perceived to be associated to low resident quality of life. The implication for social change is that nursing home stakeholders may develop processes to retain competent administrators which in turn could reduce absent leadership presence in nursing homes. Consistent leadership presence may lead to improvement in quality of life regulatory compliance and reduction in unnecessary Medicare and Medicaid spending by nursing home residents.
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Cohn, Arthur M. "Effectiveness of nursing home administrators /." The Ohio State University, 1988. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487596307358779.
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Sheehy, Christine M. "Differences in Nursing Home Utilization and Clinical Outcome in Veterans Administration Nursing Home Patients." VCU Scholars Compass, 1987. https://scholarscompass.vcu.edu/etd/5520.
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Because of increasing costs and demand for nursing home care, studies are needed that can better describe the population of users and improve prediction of clinical outcomes and program requirements. The major purpose of this study was to explore the incremental and seven month outcomes of nursing home patients using the Andersen model. The design was longitudinal. Patients from one Veterans Administration (VA) hospital-based nursing home and six freestanding. VA contract community nursing homes were studied. Functional and cognitive ability were analyzed along with socioeconomic and demographic data. and utilization patterns.
A second purpose was to assess associations among variables and their interaction effects in predicting outcome. A third purpose was to assess the contribution of such independent variables as case-mix and rehospitalization rates to possible cost differences evidenced by the two nursing home types. The results of this study suggest avenues for planning and allocation of resources in the two program alternatives.
The Barthel Index (BI) (Mahoney & Barthel. 1965) was used to measure functional status and the Short Portable Mental Status Questionnaire (SPMSQ) (Pfeiffer. 1975) for cognitive ability. In addition to standardized measures. sociodemographic and utilization data. perceptions of health and outcomes of care were collected on all subjects.
Analytical techniques included descriptive and inferential statistics. The major hypothesis was that veterans in the hospital-based versus contract statistically significant differences in characteristics and on measures of service use and clinical outcome. Findings were evaluated for policy adequacy. adherence to program intent. federal and state cost complement and other qualitative implications.
Statistically significant differences were found between patients in the two settings on predisposing, enabling and need characteristics. The hospital-based NHCU patients were more likely to be married and living with someone. They also had higher incomes, more Medicare A coverage, a greater percentage of service-connected veterans and demonstrated greater limitation in functional ability than did those in contract.
The predominant outcome for both groups was continued nursing home care. Statistically significant differences were also found for outcome measures. Higher income and being 76 years or older were predictive of continued nursing home residence. The type of nursing home was not significant in explaining continued care. The total number of diagnoses. age group and type of nursing home were predictive of death as an outcome. There were significantly more deaths among those 75 years or younger. among those with lower incomes and among NHCU patients.
Health service utilization did not differ significantly by nursing home type. Neither group of nursing home patients demonstrated any significant improvement in functional or mental status and self-perceived health. The only differences of note were among those 75 years or less who did improve in functional ability from the third to the sixth month.
The findings suggest that the two nursing home types do have different patient population profiles. However. the continued use of nursing home care by both groups indicates some lack of fit between legislative intent and actual clinical utilization.
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MaGee-Rodgers, Tamiko R. "Character Strengths of Nursing Home Administrators Who Lead Exemplary Long-Term Care." Thesis, Indiana Wesleyan University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10930255.
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The growth in the older adult population will result in an increasing number of individuals with functional and cognitive limitations. The demand for nursing home administrators will grow proportionately with the aging population and the need for effective leadership within nursing homes is and will continue to be imperative as the population ages. Identifying top-rated nursing homes that provide quality care is essential to understanding the operations of successful long-term care facilities. Nursing home administrators (NHAs) are tasked with leading and directing provision of skilled, intermediate and rehabilitation care on a 24-hour basis while ensuring high quality operations. Identifying the character strengths of nursing home administrators who lead exemplary nursing homes may benefit other nursing home leaders who lead lower rated or underperforming facilities. In this qualitative study, 19 nursing home administrators who lead exemplary facilities across Indiana completed the Value in Action Inventory Strengths (VIA-IS) questionnaire and engaged in face-to-face interviews. Analysis of the interview data via NVivo indicated how the use of character strengths is crucial to effective leadership within long-term care. Creativity, fairness, bravery, perspective, and judgment were identified by a majority of study participants as essential to decisionmaking and problem solving, especially in a heavily regulated environment. Humor, hope, courage, and spirituality were acknowledged as contributing to a positive and optimistic environment. Humor, hope, courage, and spirituality were also noted as coping mechanisms when faced with stress and adversity. Honesty, kindness, love, teamwork, and gratitude were emphasized by the study participants as essential to relationship development and formation of trust with staff, residents, and families. This study allowed participants the opportunity to reflect on their own character strengths and leadership both personally and professionally. This reflection resulted in increased self-awareness and appreciation of their staff, residents, and roles as nursing home administrators.
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Law, Emma. "Research in care homes : issues of participation and citizenship." Thesis, University of Stirling, 2016. http://hdl.handle.net/1893/25305.
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Across Scotland, there is a lack of research in care homes. This thesis explores this topic by examining links between inclusion, participation in general and participation in research and whether those who work and live in the care home environment experience social citizenship. Using a national survey and interviews with residents, staff, relatives and experts in care home research, this thesis investigated whether participation generally was linked to participation in research for residents, staff and visitors in a care home setting. The thesis further explored how social citizenship functions in a care home environment and whether there is a link between participation and citizenship. The findings suggest there is a lack of general participation which is connected with the leadership style and management within the care homes. There is misunderstanding about research and legislation amongst the care home staff, residents, visitors, as well as the junior research staff which inhibited staff and resident participation. Furthermore, citizenship is not experienced universally by residents or staff due to disempowerment, and exclusion occurs amongst residents due to age, frailty and dementia. By facilitating good leadership, communication and relationship-building such issues may be overcome. In addition, the analysis suggests a link is evident between inclusion, participation and citizenship. Where choice is provided and residents have their social position maintained, as well as have a degree of responsibility for shaping events, this leads to participation and inclusivity as described in Bartlett and O’Connor’s (2010) definition of social citizenship. Furthermore, if inclusion is adapted for cognition and frailty, then participation leads to the experience of social citizenship, encouraging a culture which can welcome research. The explicit emphasis on inclusion and participation in research has enabled this under-researched area of participation and experience of social citizenship in care homes to be more fully explored.
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Thomas, Cynthia M. "Issues of concern for directors of nursing in long term care." Virtual Press, 1999. http://liblink.bsu.edu/uhtbin/catkey/1154778.
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Health care delivery has changed and the long term care facility has residents with more complex medical problems. The director of nursing (DON) faces many problems and stressors, is often dissatisfied and leaves the position within the first two years. This turnover is associated with increased cost to the facility, decrease in the quality of care provided to residents and an increase in the turnover rate of the nursing staff. While the turnover problem is significant to the agency and the industry, little has been accomplished to correct the situation.The purpose of this descriptive study was to examine the stressors and emotions that are associated with the tenure and job satisfaction of directors of nursing in long term care. The theoretical framework for this study was the revised causal model of job satisfaction developed by Agho, Mueller and Price (1993).Participants were obtained from a current list from the National Association of Director's of Nursing Administration/Long Term Care (NADONA/LTC). The population was 400 directors of nursing currently employed in long term care. The sample of 134 (34%) was obtained from the completed questionnaires. Participants completed two questionnaires about the stressors of the director's position and demographics. The procedures for the protection of human subjects were followed.Findings supported Agho, Mueller and Price's (1993) revised causal model of job satisfaction. In this study (39.6%) of the DONs reported they would not leave the position even if there were other opportunities elsewhere. This was in spite of 67 (50%) who stated the area they worked in had other nursing opportunities. DONs (77.7%) had a great deal of freedom to make decisions in the job, supporting Agho et al., (1993) findings that autonomy was important to job satisfaction as an abstract concept. Role overload was also cited by Agho et al., (1993) to effectjob satisfaction. The majority of respondents ( n = 123; 92.5%) believed the job to be stressful yet 78 (58.6%) did not leave work with feelings of failing, as well as 119 (88.8%) saw their work as having a greater purpose. This finding did not support Agho et al. (1993) model.In spite of being stressed and dealing with a high degree of repetition 83 (62.4%) of the DONs had a high degree of job satisfaction with the current position and 94 (70.2%) felt fulfilled. Believing DONs could make a positive change in the career was expressed by 115 (85.9%) which supports Agho et al. (1993) work motivation or the belief in the centrality of the work role in one's life. Findings did not support the current trend for advanced education as preparation for the position. The DONs (61.6%) in this study believed that an associate degree or diploma was adequate preparation for the position.In conclusion the DONs participating in the study were able to identify areas of stress and issues of concern which impact job satisfaction and tenure. Findings suggested that to retain a DON in long term care the administrator and staff must be supportive of decisions made while managing the department. DONs indicated jobs were stressful, required long hours, and involved dealing with staff conflict which created stressors. However, individuals loved the work, because individual believed some good was being accomplished and making a difference in people's lives which made the stress tolerable. Findings suggest the majority of the DONs remain in the position for personal satisfaction.Implications from this study suggested that the tenure and job satisfaction of the DON in long term care can be lengthened and strengthened to improve and stabilize long term care facilities and the industry as a whole. Quality of care, staffing turnover and negative/positive cost to the facility hinges on the tenure of the DON. Long term care directors may need advanced education to manage stress and handle complex daily decisions. Directors need a sense of support from the administrator and the staff to develop autonomy. Directors need to be involved in nursing organizations and hold certifications that support and provide some stature to the position. Directors may need to unite and lobby to create change in the long term care industry.School of Nursing
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Payne, Regina L. Lynn Mary Ann. "Selected relationships among demographic, career, organization, job satisfaction, and job attachment variables for directors of nursing in nursing homes." Normal, Ill. Illinois State University, 1985. http://wwwlib.umi.com/cr/ilstu/fullcit?p8525563.
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Thesis (Ed. D.)--Illinois State University, 1985.Title from title page screen, viewed June 23, 2005. Dissertation Committee: Mary Ann Lynn (chair), Kenneth Strand, David Eaton, John McCarthy, J.H. McGrath. Includes bibliographical references (leaves 207-218) and abstract. Also available in print.
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Wike, Christopher L. Wircenski Jerry L. "Intent to quit perceptions of nursing assistants working in Oklahoma state veterans administration-owned and administered nursing homes." [Denton, Tex.] : University of North Texas, 2007. http://digital.library.unt.edu/permalink/meta-dc-3903.
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Wike, Christopher L. "Intent to quit perceptions of nursing assistants working in Oklahoma state veterans administration-owned and administered nursing homes." Thesis, University of North Texas, 2007. https://digital.library.unt.edu/ark:/67531/metadc3903/.
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The purpose of this study was to examine a select set of organizational variables and determine their relationship to nursing assistants' intentions to quit in state-owned veterans' long-term care facilities located across the United States. America's long-term care industry (e.g., nursing homes, assisted living facilities) is a multibillion dollar industry. Because the U.S. government is projecting a 250% increase in the elderly population, staffing these nursing homes and related facilities is a critical concern. A vitally important but often overlooked factor of the long-term care industry is employee turnover. Of the staff in long-term care facilities, the nursing assistant (NA) position is particularly susceptible to turnover. Approximately 80% of NAs who enter the workforce leave within the 1st year and many leave within the first 3 months of employment. Some facilities report that they are unable to accept new residents because of a lack of qualified NAs. While many studies have researched this issue, staff turnover in long-term care facilities remains a serious and widespread problem. This study provides a foundation for future research related to the perceptions of intentions to quit of nursing assistants (NAs) working in state-owned veterans long-term care facilities by providing primary data regarding NAs intentions to quit. Results of this study indicate that NA intentions to quit might be reduced provided that pay and rewards are increased, workplace violence is addressed, and better access to patient care plans is provided. This research is useful to state-owned and operated long-term care facilities by giving them additional insights into nursing assistants' intentions to quit perhaps resulting in lower rates of turnover. It is suggested that future research be performed using populations of individuals from other segments of the long-term care industry, mainly, for-profit institutional care nursing homes, and federally owned veterans long-term care facilities.
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Peoples, Paula Beth. "Pay-per-visit for Home Health Agency nurses." CSUSB ScholarWorks, 1997. https://scholarworks.lib.csusb.edu/etd-project/1410.
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Lin, Chun-Chieh. "Nursing Home Organizational Characteristics and Utilization of Cancer-Related Medical Services." VCU Scholars Compass, 2010. https://scholarscompass.vcu.edu/etd/2043.
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Cancer is the second leading cause of death in the U.S and is more common among the elderly. Since frailty and other age related conditions put the elderly at risk for nursing home care, nursing homes may be the site of care and death for many elderly cancer patients. However, there is a large gap in knowledge concerning cancer treatment of elderly nursing home residents. Since residents rely heavily on their nursing facilities, nursing homes might influence them in their treatment decisions. After controlling for resident and nursing home market characteristics, this study applies Andersen’s Behavioral Model to examine whether nursing home organizational characteristics (nurse staffing level, nursing skill mix, and quality deficiencies) are related to the use of cancer-related medical services for treatment (oncologist visits, cancer-directed surgery, chemotherapy or radiation therapy), and palliative care (pain medication and hospice services) among 1,183 Medicaid and Medicare insured residents of nursing homes in Michigan from 1996-2000. Using data from the Medicare claim file, Medicaid claim file, Michigan tumor registry, Area Resource File, Michigan Medicaid Nursing Home Cost Report, and Online Survey, Certification and Reporting (OSCAR), the study used logistic regression to predict the utilization of cancer-related medical services. The results generally did not support the hypotheses. Nursing staffing level and nursing skill mix did not predict any cancer-related medical service utilization. Cancer care may be more associated with patient characteristics, such as age, which are usually taken into consideration when physicians suggest treatments, than nursing home organizational characteristics. However, relative to residents of nursing homes with the highest quartile of quality deficiencies, residents of nursing homes in the lowest quartile of quality deficiencies had a decreased likelihood of utilizing hospice care (OR=.509; 95%CI=.325 to .796; p=.003). Residents in high quality nursing homes may want to stay in the same place and not transfer to another facility for hospice care while residents in poor quality nursing homes may be motivated to use hospice care. Even though this study did not successfully find that higher nurse staffing level, nursing skill mix, quality of care are associated with greater opportunity of utilizing cancer-related medical services, this study was successful in laying out an empirically sound base framework to analyze this association. Future research can incorporate other states or nationwide data to re-examine this relationship using this study as a base model.
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Walthour, Renee. "Successful Strategies for Financial Sustainability in Nursing Homes." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4950.
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From 2014 to 2015, deficiency fines cost Pennsylvania nursing homes more than $2.5 million. Costs associated with adhering to increased health care regulations can reduce profit and affect the financial sustainability of the nursing home industry. Some nursing home administrators (NHAs) lack successful strategies to improve state and federal regulation compliance and promote financial sustainability. Drucker's management by objectives theory was the conceptual framework for this study. The purpose of this qualitative multiple case study was to explore successful strategies NHAs use to improve state and federal regulation compliance to mitigate deficiencies and derivative fines to promote financial sustainability of nursing homes. NHAs who manage 5-star rated nursing homes within a 100-mile radius of Pittsburgh, Pennsylvania use effective management strategies to mitigate deficiencies and derivative fines to earn a 5-star rating which, helps promote financial sustainability. Data were collected from semistructured face-to-face and telephone interviews with 4 NHAs and from Medicare's Nursing Home Compare website. The data on the website provided information on the 3 domains of health inspections, staffing, and quality measures, that made up the overall star rating of nursing homes. Data were analyzed using Yin's 5-phase cycle. The findings revealed 3 major themes: develop knowledgeable staff, enhance communication with staff and residents, and promote innovation for continuous quality improvement. The implications for positive social change could include increased quality of patients' health care, creation of employment opportunities to promote prosperity in communities, and financial sustainability in the United States nursing home industry.
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DeLellis, Nailya. "Determinants of Nursing Home Performance: Examining the Relationship Between Quality and Efficiency." VCU Scholars Compass, 2009. https://scholarscompass.vcu.edu/etd/2050.
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Determinants of nursing home performance: examining the relationship between quality and efficiency By Nailya O. DeLellis, MPH, Ph.D. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2010 Director: Dr. Yasar Ozcan, Professor, Department of Health Administration To assess the relationship between quality of care and efficiency of nursing homes this study used 10% random sample of non-hospital based nursing homes of size 20-360 beds and occupancy rate of 5-100% in OSCAR database 2008 (n=1430). Data Envelopment Analysis was used to calculate efficiency score and Structural Equations Modeling was used to assess the effect of environmental factors on efficiency score and quality measures as well as relationship between efficiency and quality of care. Logistic regression was performed to find the factors that affect high performance, defined as high efficiency and high quality. In the study’s sample, 149 facilities (10.4%) had an efficiency score of 1, which indicates perfect efficiency. The average efficiency score of nursing homes in the sample was 0.854 (0.079 min; 0.145 std). Competition positively affects efficiency, with a path coefficient 0.09 (t-value = 2.65). Although the path coefficients relating competition with process and with outcome quality were positive (0.08 and 0.04, respectively), the results were not statistically significant. Stronger position of payers in the market positively affects process quality of care (path coefficient = 0.15, (t-value = 2.48). Higher efficiency of nursing homes is associated with higher outcome quality (path coefficient of 0.06, t-value = 1.99), but lower process quality (path coefficient of –0.20 , t-value = –2.95). Only 7.4% of nursing homes in the sample could efficiently provide high quality services, which was defined as high performance in the study. Among the factors that demonstrated statistically significant coefficients in the regression were the size of a facility, the availability of registered nurses, excess demand, and for-profit status. The study provides evidence of the trade-off between efficiency and process quality, in which higher efficiency of a nursing home is associated with lower process quality of care. Findings in the study also suggested that higher efficiency is associated with higher outcome quality.
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Gilyard, Ameer. "Implementation Strategies for Quality Assurance Performance Improvements in Nursing Homes." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5466.
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The healthcare industry, and more specifically the nursing home sector, is changing operations and services due to a healthcare mandates and enactment of the 2010 Affordable Care Act. Such changes are termed quality assurance performance improvements (QAPI), to receive government subsidies and indemnification compensations. The purpose of this single case study was to explore effective strategies implemented by 4 healthcare leaders to comply with QAPI regulations. Total quality management theory was the conceptual framework used in this study. Data were collected through semistructured, open-ended, face-to-face interviews with 4 participants who serve in a management capacity at an organization located in northwest Missouri. Member checking was used to strengthen the credibility and trustworthiness of the interpretation of the participants' responses. The emergent themes from the study were (a) quality planning using systematic and strategic approaches, (b) quality control using business instruments and tools to measure performance and progress, (c) quality assurance through internal and external systematic analysis, and (d) quality improvements using an integrated systems approach. The implications for positive social change include the potential optimization of care provided to consumers in nursing homes by identifying best practices and strategies healthcare and business professionals have used to modify their business processes and operations.
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Green, Sashai A. "Cultural competence in long term care : a qualitative phenomenological study of nursing home administrators' knowledge and perception of cultural competence." Honors in the Major Thesis, University of Central Florida, 2009. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/1265.
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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.Bachelors
Health and Public Affairs
Health Services Administration
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Amirkhanyan, Anna A. "The smart-seller challenge the determinants and the outcomes of privatizing public nursing homes /." Related electronic resource: Current Research at SU : database of SU dissertations, recent titles available full text, 2005. http://wwwlib.umi.com/cr/syr/main.
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Tessier, Terah. "Relationship between Nurse Training and Physical Restraints in Nursing Homes." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2697.
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According to the Centers for Medicare and Medicaid Services (CMS), approximately 1.3 million U.S. residents are residing in nursing homes. CMS enforced regulations in the Nursing Home Reform Act. Training in the use of restraints in nursing homes is monitored through the CMS standards. The purpose of this study was to determine whether there was a correlation between training standards of health care practitioners and their use of restraints in nursing homes based on the patterns of citations by RNs and CNAs. Data were collected from Kansas, Louisiana, and Ohio within the CMS Nursing Home Data Compendium. The key research question examined differences in standard training requirements, policies, and citations regarding restraint use in the selected states. The theoretical framework for this study was the social influence theory. The results of the analysis of variance indicated that between 2008 and 2012, there were significant differences in policy and standards requirements for the training of registered nurses and certified nursing assistants regarding restraint use; there was also a relationship between the training of staff and the number of citations of restraint use in Kansas, Louisiana, and Ohio. There were significant (p < .02) variations throughout the 3 states regarding the policies, procedures, and training expectations. The positive social change that could result from these findings is the standardization of training that may help decrease restraint use and become the foundation of more respectful and caring practices in nursing homes.
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Kercado, Veronica. "Relationship Between Nurse Staffing and Quality of Care in Louisiana Nursing Homes." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2215.
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In 2014, Louisiana experienced substantive issues with quality of care in nursing homes. The state had the lowest nurse staffing level among all states, and 7,666 deficiencies for immediate jeopardy violations were recorded from 2011 to 2013. Despite ample research on nurse staffing and quality of care, there is no consensus on how higher nurse staffing relates to quality. The purpose of this quantitative, correlational research was to determine the relationship between nurse staffing levels and quality measures in Louisiana. Donabedian's category structure, process, and outcome was the conceptual framework used to develop the research questions. The data included the quality of care deficiency score and the quality measures found in the Centers for Medicare and Medicaid datasets. The quality measures were the deficiencies and the prevalence of nursing home residents with pressure ulcers, urinary tract infections, and physical restraints. Generalized linear models were used to analyze the relationship between nurse staffing levels and the quality measures. The findings suggested that RNs, nonprofits, chain-affiliated nursing homes, and smaller facilities are important to improve the quality of care in Louisiana nursing homes. These variables were associated with fewer quality of care deficiencies and fewer pressure ulcers. These findings have implications for social change. This information may help inform and direct policy makers in the development and implementation of Medicaid-managed long-term services and supports programs in order to improve the quality of care of a vulnerable population: the elderly and disabled.
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Pimentel, Camilla B. "Use of Opioids for Pain Management in Nursing Homes: A Dissertation." eScholarship@UMMS, 2015. https://escholarship.umassmed.edu/gsbs_diss/773.
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Nursing homes are an essential yet understudied provider of cancer-related care for those with complex health needs. Nine percent of nursing home residents have a cancer diagnosis at admission, and it is estimated that one-third of them experience pain on a daily basis. Although pain management is an essential component of disease treatment, few studies have evaluated analgesic medication use among adults with cancer in this setting. Use of opioids, which are the mainstay of pain management in older adults because of their effectiveness in controlling moderate to severe pain, may be significantly related to coverage by the Medicare Part D prescription drug benefit. However, little is known about Medicare Part D’s effects on opioid use in this patient population. A limited body of evidence also suggests that despite known risks of overdose and respiratory depression in opioid-naïve patients treated with long-acting opioids, use of these agents may be common in nursing homes.
This dissertation examined access to appropriate and effective pain-related health care services among US nursing home residents, with a special focus on those with cancer. Objectives of this dissertation were to: 1) estimate the prevalence, and identify resident-level correlates, of pain and receipt of analgesic medications; 2) use a quasi-experimental research design to examine the relationship between implementation of Medicare Part D and changes in the use of fentanyl patches and other opioids; and 3) to estimate the prevalence, and identify resident-level correlates, of naïve initiation of long-acting opioids. Data on residents’ health status from the Resident Assessment Instrument/Minimum Data Set (versions 2.0 and 3.0) were linked with prescription drug transaction data from a nationwide long-term care pharmacy (January 2005–June 2007) and the Centers for Medicare and Medicaid Services (January–December 2011).
From 2006 to 2007, more than 65% of residents of nursing homes throughout the US with cancer experienced pain (28.3% on a daily basis), among whom 13.5% reported severe pain. More than 17% of these residents who experienced daily pain received no analgesics (95% confidence interval [CI]: 16.0–19.1%), and treatment was negatively associated among those with advanced age, cognitive impairment, feeding tubes, and restraints. These findings coincided with changing patterns in opioid use among residents with cancer, including relatively abrupt 10% and 21% decreases in use of fentanyl patches and other strong opioids, respectively, after the 2006 implementation of Medicare Part D. In the years since Medicare Part D was introduced, some treatment practices in nursing homes have not been concordant with clinical guidelines for pain management among older adults. Among a contemporary population of long-stay nursing home residents with and without cancer, 10.0% (95% CI: 9.4–10.6%) of those who began receiving a long-acting opioid after nursing home admission had not previously received opioid therapy. Odds of naïve initiation of these potent opioids were increased among residents with terminal prognosis, functional impairment, feeding tubes, and cancer.
This dissertation provides new evidence on pharmaceutical management of pain and on Medicare Part D’s impact on opioid use in nursing home residents. Results from this dissertation shed light on nursing home residents’ access to pain-related health care services and provide initial directions for targeted efforts to improve the quality of pain treatment in nursing homes.
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Pimentel, Camilla B. "Use of Opioids for Pain Management in Nursing Homes: A Dissertation." eScholarship@UMMS, 2004. http://escholarship.umassmed.edu/gsbs_diss/773.
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Nursing homes are an essential yet understudied provider of cancer-related care for those with complex health needs. Nine percent of nursing home residents have a cancer diagnosis at admission, and it is estimated that one-third of them experience pain on a daily basis. Although pain management is an essential component of disease treatment, few studies have evaluated analgesic medication use among adults with cancer in this setting. Use of opioids, which are the mainstay of pain management in older adults because of their effectiveness in controlling moderate to severe pain, may be significantly related to coverage by the Medicare Part D prescription drug benefit. However, little is known about Medicare Part D’s effects on opioid use in this patient population. A limited body of evidence also suggests that despite known risks of overdose and respiratory depression in opioid-naïve patients treated with long-acting opioids, use of these agents may be common in nursing homes.
This dissertation examined access to appropriate and effective pain-related health care services among US nursing home residents, with a special focus on those with cancer. Objectives of this dissertation were to: 1) estimate the prevalence, and identify resident-level correlates, of pain and receipt of analgesic medications; 2) use a quasi-experimental research design to examine the relationship between implementation of Medicare Part D and changes in the use of fentanyl patches and other opioids; and 3) to estimate the prevalence, and identify resident-level correlates, of naïve initiation of long-acting opioids. Data on residents’ health status from the Resident Assessment Instrument/Minimum Data Set (versions 2.0 and 3.0) were linked with prescription drug transaction data from a nationwide long-term care pharmacy (January 2005–June 2007) and the Centers for Medicare and Medicaid Services (January–December 2011).
From 2006 to 2007, more than 65% of residents of nursing homes throughout the US with cancer experienced pain (28.3% on a daily basis), among whom 13.5% reported severe pain. More than 17% of these residents who experienced daily pain received no analgesics (95% confidence interval [CI]: 16.0–19.1%), and treatment was negatively associated among those with advanced age, cognitive impairment, feeding tubes, and restraints. These findings coincided with changing patterns in opioid use among residents with cancer, including relatively abrupt 10% and 21% decreases in use of fentanyl patches and other strong opioids, respectively, after the 2006 implementation of Medicare Part D. In the years since Medicare Part D was introduced, some treatment practices in nursing homes have not been concordant with clinical guidelines for pain management among older adults. Among a contemporary population of long-stay nursing home residents with and without cancer, 10.0% (95% CI: 9.4–10.6%) of those who began receiving a long-acting opioid after nursing home admission had not previously received opioid therapy. Odds of naïve initiation of these potent opioids were increased among residents with terminal prognosis, functional impairment, feeding tubes, and cancer.
This dissertation provides new evidence on pharmaceutical management of pain and on Medicare Part D’s impact on opioid use in nursing home residents. Results from this dissertation shed light on nursing home residents’ access to pain-related health care services and provide initial directions for targeted efforts to improve the quality of pain treatment in nursing homes.
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Alcusky, Matthew. "Anticoagulant Use, Safety and Effectiveness for Ischemic Stroke Prevention in Nursing Home Residents with Atrial Fibrillation." eScholarship@UMMS, 2019. https://escholarship.umassmed.edu/gsbs_diss/1034.
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Background
Fewer than one-third of nursing home residents with atrial fibrillation were treated with the only available oral anticoagulant, warfarin, historically. Management of atrial fibrillation has transformed in recent years with the approval of 4 direct-acting oral anticoagulants (DOACs) since 2010.
Methods
Using the national Minimum Data Set 3.0 linked to Medicare Part A and D claims, we first described contemporary (2011-2016) warfarin and DOAC utilization in the nursing home population (Aim 1). In Aim 2, we linked residents to nursing home and county level data to study associations between resident, facility, county, and state characteristics and anticoagulant treatment. Using a new-user active comparator design, we then compared the incidence of safety (i.e., bleeding), effectiveness (i.e., ischemic stroke), and mortality outcomes between residents initiating DOACs versus warfarin (Aim 3).
Results
The proportion of residents with atrial fibrillation receiving treatment increased from 42.3% in 2011 to 47.8% as of December 31, 2016, at which time 48.2% of treated residents received DOACs. Demographic and clinical characteristics of residents using DOACs and warfarin were similar in 2016. Half of the 8,734 DOAC users received standard dosages and most were treated with apixaban (54.4%) or rivaroxaban (35.8%) in 2016.
Compared with warfarin, bleeding rates were lower and ischemic stroke rates were higher for apixaban users. Ischemic stroke and bleeding rates for dabigatran and rivaroxaban were comparable to warfarin. Mortality rates were lower versus warfarin for each DOAC.
Conclusions
In nursing homes, DOACs are being used commonly and with equal or greater benefit than warfarin.
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Ueal, Jr Ozell. "An Evaluation of Robotics in Nursing Homes to Reduce Adverse Drug Events." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/3330.
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Adverse drug events (ADE) cause many deaths annually in addition to affecting the quality of life of many others. The descriptive mixed methods approach, specifically exploratory case study and experimental design that guided this research utilized the survey and focus group methods to evaluate perceptions about robotic technology (RT) to reduce the rate of ADEs in U.S. nursing homes (NH). There is a lack of scholarly research into whether a conceptual approach rooted in RT can be implemented to assist with drug administrations in NHs. The purpose of this study was twofold. The first purpose was to evaluate the causes of ADEs specifically related to tablets, capsules, and pills. The second purpose was to evaluate the perceptions of nurses and administrators relative to the use of RT to assist in reducing ADEs. In the quantitative part, the sample means from 102 surveys from nurses and administrators were evaluated with the t test and the paired t test; while in the qualitative part, survey results, reported errors, and focus group data was assessed collectively. The research results did not indicate any new causes of ADEs and showed that the participants had a favorable perception of RT. Based on the results of this research, RT may be tailored in such a way that it can significantly reduce ADE occurrences for citizens in U.S. NHs.
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Bigger, Sharon. "Advance Care Planning Protocols and Hospitalization, Rehospitalization, and Emergency Department Use in Home Health." Digital Commons @ East Tennessee State University, 2021. https://dc.etsu.edu/etd/3858.
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Aim. The aim of this study was to examine the relationship of advance care planning protocols with hospitalization, rehospitalization, and emergency department use rates in U. S. home health agencies (HHA).
Background. Since 2003, CMS has required HHAs to report on quality outcomes such as hospitalization, rehospitalization, and emergency department use rates, made publicly available online. Advance care planning (ACP) is a conversation about beliefs, goals, values, future treatment choices, and designation of a surrogate decision-maker, that someone has in advance of a health crisis. Most existing studies on ACP have taken place outside of HHAs among populations with serious illnesses such as HIV/AIDS, cancer, dementia, and end stage renal disease. Meanwhile, the U.S. home health population is living longer with chronic conditions such as pulmonary and cardiovascular illnesses. Effective January 1, 2016, the Center for Medicare and Medicaid Innovation implemented the Home Health Value-Based Purchasing (HHVBP) Model among home health agencies (HHAs) in nine states representing each geographic region in the United States. Agencies in these states began competing on value in the HHVBP model, and reimbursement rates began to be tied to quality performance (innovation.cms.gov). As part of HHVBP, CMS implemented an additional process-level mandate requiring them to report on ACP, though this data is not publicly available. It is currently unknown how ACP protocols in HHAs may affect agencies’ overall rates of acute care services use.
Methods. Electronic surveys about ACP protocols were distributed to HHAs. Existing data about demographics, diagnoses, hospitalization, rehospitalization, and ED use were accessed online via CMS websites. Descriptive and regression analyses were conducted using the electronic survey results and the existing data.
Results. Associations between the variables were observed and compared to the hypotheses. Statistical significance was found in the relationship between ACP protocols and hospitalization, where one increased the other increased. Several trends were found: Agencies with increased total percentage of cardiac and pulmonary diagnoses tended to have increased hospitalization rates; agencies with increased average age of patients tended to have increased ACPP scores; and agencies with increased proportion of Black patients tended to have higher hospitalization rates.
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Andrews, Sheila Bernadette. "Skilled nursing facility based rehabilitation outcomes of the geriatric stroke patient." CSUSB ScholarWorks, 1995. https://scholarworks.lib.csusb.edu/etd-project/1000.
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Major, Yolanda. "Effect of Home Telehealth on Vterans with Chronic Heart Failure." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2609.
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More than 5 million Americans have heart failure, with approximately 5% of those affected being veterans. As the number of patients with CHF continues to rise, new treatment options are needed to improve the quality of care. Current studies show Telehealth is one treatment option. The purpose of this scholarly project was to determine if veterans diagnosed with CHF were able to maintain optimal weight and blood pressure following participation in Care Coordination Home Telehealth (CCHT) program. The CCHT program provides care to veterans, through the use of monitoring devices placed in their home. Bandura's self-efficacy theory was used as a guide to develop veterans' self-management skills. A retrospective chart review was conducted on 26 veterans with CHF enrolled in the CCHT program. Post participation weight and blood pressure were analyzed at 16 weeks to determine whether there was a difference from the pre-participation measures. There was no change in systolic blood pressure, diastolic blood pressure, or weight levels during the 16-week period. Limitations of this project were the small sample size (n = 26), attrition rate (n = 43), no data on nurse interaction, and a short follow-up period. Implications for nursing practice and enhancing the program's efficacy are recommended. This scholarly project has the potential to support social change by expanding veteran's access to care.
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Hawks, Beth A. "The Regulation of U.S. Nursing Homes| An Examination of State and Federal Tools and Their Effect on Providers' Performance." Thesis, American University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10841150.
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This dissertation used a mixed-methods approach to investigate both how intergovernmental relationships influence collaboration between regulators and to what extent their regulatory tools affect nursing home regulatory violations. Chapter 1 examines the impact of the five-star quality rating system and market competition on nursing home violations. Chapter 2 explores the intergovernmental relationships between state and federal regulators and whether it is facilitated by collaborative action. Chapter 3 evaluates the impact of two government tools (one direct and one indirect) and their association with regulatory compliance in nursing homes. The findings suggest that the five-star quality rating system has a positive association with nursing home providers’ regulatory compliance. Meanwhile, communication among regulators appears to be the key to collaboration, and the current structure of their regulatory regime might be inhibiting collaboration. Furthermore, the findings suggest that the direct governance tool leads to improvements in subsequent regulatory compliance as compared to the indirect tool. These three essays on the intergovernmental regulation of nursing homes and the specific regulatory tools contribute to the future policy decisions that affect the well-being of approximately 1.4 million individuals residing in nursing homes and primarily funded by the public.
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Burns, Diane Sutton. "A financial analysis of a Southern California Coalition of Visiting Nurse Associations." CSUSB ScholarWorks, 1994. https://scholarworks.lib.csusb.edu/etd-project/922.
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Whitaker, Lisa. "Employee Satisfaction with Supervisor Support: The Case of Direct Care Workers in Nursing Homes." Thesis, University of North Texas, 2017. https://digital.library.unt.edu/ark:/67531/metadc1062874/.
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The nursing home industry has been saturated for decades with culture change initiatives in an effort to improve resident quality of care. The direct care worker (DCW) is considered a critical position to achieving nursing facility quality improvements. Understanding what leads to job satisfaction for DCWs could result in improved resident care. The relationship DCWs have with their direct supervisor or upper-level manager can impact employee satisfaction. The purpose of this research is to identify factors that are associated with DCWs satisfaction with supervisor and management support. Data was obtained from 307 DCWs who were employed at 11 North Texas nursing homes. It was expected that factors affecting satisfaction with direct supervision and upper-level management would differ. In fact, the study found that the antecedents for employee satisfaction with supervisor support were participative decision-making/empowerment, age, information exchange and feedback. Furthermore, participative decision-making/empowerment, perceived competence, staffing, information exchange and feedback were found to affect direct care workers' satisfaction with manager support. In conclusion, this research provides a starting point towards a more holistic view of employee satisfaction with supervisor support by considering the preceding factors and its subsequent effects.
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Falkenstrom, Mary Kate. "Exploratory Study of Nurse-Patient Encounters in Home Healthcare: A Dissertation." eScholarship@UMMS, 2016. https://escholarship.umassmed.edu/gsn_diss/45.
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The purpose of this study was to explore nurse-patient encounters from the perspective of the Home Healthcare Registered Nurse. A qualitative descriptive design was used to collect data from a purposive sample of 20 home healthcare registered nurses from Connecticut, Massachusetts, and Rhode Island currently or previously employed as a home healthcare nurse. Four themes and one interconnecting theme emerged from the data: Objective Language; Navigating the Unknown; Mitigating Risk; Looking for Reciprocality in the Encounter; and the interconnecting theme of Acknowledging Not All Nurse-Patient Encounters Go Well. One goal of the study was to propose an empirically informed definition of what constituted a difficult encounter. An important early finding was that the terms difficult patient and difficult encounter were not generally used by study participants. HHC RNs voiced a preference for objective and nonjudgmental language to communicate outcomes of nurse-patient encounters. Three types of HHC RN-patient interactions emerged from the data, with constructive encounters the norm and non-constructive or destructive encounters less frequent. A constructive encounter is when two or more human beings, the nurse on the one side, and the patient, caregiver, or both on the other, interact to achieve a mutually agreed upon outcome. A nonconstructive encounter is when one or more human beings obstruct efforts to achieve at least one positive outcome. A destructive encounter is when one or more human beings direct anger at or physically aggress toward another human being. Strategies to promote reciprocality are routinely employed during HHC RN-patient encounters, but HHC RNs who miss cues that a strategy is ineffective or failed may be at risk in the home. Study data lend support to key concepts, assumptions, and propositions of Travelbee’s (1971) Human-to-Human Relationship Model. Study results provide a foundation for further research to increase the understanding, recognition, and development of empirically derived responses to non-constructive or destructive encounters such that HHC RNs are safe and best able to meet patients’ healthcare needs.
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Ucar, Bulent. "The Effectiveness of Religion-Affiliated Nonprofit Organizations in Social Services: A Survey Study of Nursing Homes in Virginia." VCU Scholars Compass, 2011. http://scholarscompass.vcu.edu/etd/2640.
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The primary purpose of this study is to determine whether being a church affiliated nursing home influences performance. Performance is measured based on criterion put in place by the Center for Medicare and Medicaid Services (CMS). The secondary purpose is, regardless of ownership type - religiously affiliated or secular- to investigate if more religiously involved nursing homes perform better than their less religiously involved counterparts. These two purposes are hypothesized with six different hypotheses each of which are tested by utilizing OLS regression analysis. This study extensively discusses the arguments surrounding the Charitable Choice Initiative, which allowed faith-based organizations (FBOs) to compete for federal and state grants and funds without altering their religious beliefs or practices while setting up a partnership with government in delivering social services. The subject has been part of serious debates among policy makers, practitioners and scholars after President George W. Bush's creation of the White House Office of Faith-Based and Community Initiatives in 2001. This study applied self regulation theory, which is originally an individual level theory, to organizations by using metaphors, as many newly developing fields of studies have done. The self regulation theory is tested through analyzing secondary data sets that are provided by CMS and through a religiosity survey data set that this researcher collected from 218 out of 287 CMS certified nursing homes in Virginia. The relationship between religious involvements of nursing homes and their patient outcomes and health inspection outcomes are tested. The statistical analyses supported only one hypothesis out of six. Since most of the hypotheses are not supported by the findings, the theory used to explain the role of religious motivation in performance of organizations requires further testing through additional rigorous studies.
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Morin, Sheila Kenny. "Certified nursing assistants' satisfaction with education and training programs in long-term care facilities: A Massachusetts study." CSUSB ScholarWorks, 1994. https://scholarworks.lib.csusb.edu/etd-project/946.
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Abenojarj, John Paul Tuanqui. "Leadership among Directors of Social Services at Rehabilitative Healthcare Chains." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3736.
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Rehabilitation and healthcare centers (RHCs) provide ongoing care to the elderly and chronically ill. To maximize the quality of this care, RHC staff must be properly trained to respond to patient care crises and communicate across departments. Although researchers have studied the leadership styles, strategies, and interactions of facility administrators and nursing directors, there is a substantial gap in the literature on the leadership styles and strategies employed by directors of social services (DSSs). The aim of this phenomenological study was to address this gap in the research by exploring how DSSs influenced leadership policies, prepared subordinates for crisis intervention and management, perceived that social workers influenced decision-making in patient care, and believed that communication amongst RHC staff about patient care could be improved. The conceptual framework for this study was based on 3 leadership model constructs: the multilevel leadership model construct, the situational leadership model construct, and the complex adaptive leadership model construct. Participants included a purposive sample of 10 DSSs working in large, corporate RHCs in Virginia. Data were collected via in-person, semistructured interviews consisting of open-ended questions. Data were analyzed via Hycner's phenomenological approach. Findings from this investigation helped clarify roles and responsibilities of DSSs, thereby improving the leadership they provide to subordinate social workers. Findings may be used to improve communication across professionals within RHCs and emphasize the important role that social workers should play in patient care decisions.
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McManus, Lisa Sullivan. "The Patient-Centered Medical Home and Diabetes Mellitus Outcomes: A Systematic Review." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3310.
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Ineffectively managed chronic diseases such as diabetes mellitus (DM) increase overall health care expenditures and negatively affects health outcomes such as exacerbations, functional decline, disability, and death. The purpose of this systematic review (SR) was to review the DM outcomes reported by patient-centered medical homes (PCMHs). The goal was to determine how care coordination and evidence-based clinical management impacted financial and health outcomes. The SR followed the Cochrane protocol and complied with the PRISMA evidence-based minimum set for reporting. Overall, DM management in the PCMH demonstrated statistically significant completion rates for essential screenings and preventive care, including HgA1c (p = 0.0013), lipid management (p
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Morrison, Jessica. "Reducing preventable hospitalizations: A study of two models of transitional care." ScholarWorks @ UVM, 2016. http://scholarworks.uvm.edu/graddis/468.
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Purpose: Transitional care is an emerging model of health care designed to decrease preventable adverse events and associated utilization of healthcare through temporary follow-up after hospital discharge. This study describes the approach and outcomes of two transitional care programs: one is provided by masters-prepared clinical nurse specialists (CNS) with a chronic disease self-management focus, another by physicians specializing in palliative care (PPC). Existing research has shown that transitional care programs with intensive follow up reduce hospitalizations, emergency room visits, and costs. Few studies, however, have included side-by-side comparisons of the efficacy of transitional care programs varying by health care providers or program focus.
Design: This is a retrospective cohort study comparing the number of Emergency Department (ED) visits and hospitalizations in the 120 days before and after the intervention for patients enrolled in each transitional care program. Each program included post-hospitalization home visits, but included difference in program focus (chronic disease vs. palliative), assessment and interventions, and population (rural vs. urban). Data from participants in the CNS program 9/2014 ' 12/2014 were analyzed (n=98). The average age of participants was 69 and they were 65% female.
Data was collected from patients from the PC program from 9/2014 to 4/2015 (n=71). Thirty participants died within 120 days after the intervention and were excluded, the remaining 41 were included in the analysis. Participants had an average age of 81 and were 63% female.
Methods: For the CNS program, a secondary analysis of existing data was performed. For the PC program, a review of patient charts was done to collect encounters data. A Wilcoxon Matched-Pair Signed-Rank test was performed to test for significance.
Findings: Patients in the CNS intervention had significantly fewer ED visits (p
Conclusions: Both transitional programs have value in decreasing health care utilization. The CNS intervention had a more significant effect on ED visits for their target population than the PC program. Further study with randomized control trails is needed to allow for a better understanding of the healthcare workforce best fitted to enhance transitional care outcomes. Future study to examine the cost savings of each of the interventions is also needed.
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Guželienė, Ramunė. "Pensionato kontingento psichosocialiniai poreikiai, ju realizavimo strategija." Master's thesis, Lithuanian Academic Libraries Network (LABT), 2008. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2008~D_20080924_181519-45152.
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Darbo tikslas – išanalizuoti pagyvenusių žmonių, gyvenančių stacionarioje globos įstaigoje, psichosocialinių poreikių tenkinimo optimizavimą.
Tyrimo tikslas – nustatyti Veisiejų pensionato pagyvenusių žmonių poreikius ir vadybiniai sprendimai juos tenkinant.
Pagyvenę ir seni žmonės susiduria su daugeliu specifinių problemų, būdingų jų amžiaus tarpsniui. Jų statusas menkėja, vaidmenų skaičius mažėja, pamažu jie stumiami iš visuomenės gyvenimo, kol tampa nereikalingais. Dėl amžiaus vis sunkiau įsitraukti į visuomeninę veiklą, todėl pagyvenę ir seni žmonės tampa lyg atskira visuomenės dalimi. Be to silpnėja kartų solidarumas, mažėja suaugusių vaikų parama senyvo amžiaus tėvams. Senas žmogus be maisto, pastogės šilumos turi ir kitus poreikius. Šiandien tapo labai svarbu padėti žmogui nugalėti vienišumą, emocinę izoliaciją, nugalėti dvasinę krizę, kad vėl taptų save gerbiančia asmenybe.
Pensionato kontingentas – tai sergantys, negalės ištikti žmonės, našliai ir našlės arba gyvenime likę viengungiai. Tarp jų ir tie, kurie linkę su artimaisiais ir bendruomenės atstovais konfliktuoti, atlikti nuskriausto ar net kankinio vaidmenį.
Socialinių darbuotojų ir viso personalo, tiesiogiai sąveikaujančio su pensionato kontingentu veiklos strategijos pagrindą sudaro pagalbos teikimas žmogui, pakitus jo gyvenimo sąlygoms, padėti pagyvenusiam, senam žmogui susitaikyti su savo paties senėjimu, suvokti, kad kiekvienas amžiaus tarpsnis turi savo vertybes.
Atlikus tyrimą galima teigti, kad... [toliau žr. visą tekstą]The goal of this research paper is to analyse the optimization of meeting the psychomatic needs of elderly people living in nursing homes. The aim of the research is to identify the needs of the elderly in Veisejai nursing home and to produse management solutions to meeting the needs of the residents. The elderly and old people face a lot of specific problems that are typical of their age. Their status diminishes, the role in life declines as they are driven out of social life and eventually become unnecessary. Due to the age it becomes more difficult to get involved in social activity, consequently the elderly and the aged become as a separate part of a society. Moreover, due to the unemployment the solidarity of generations diminishes and the support from grown-up children decreases. Except for food and a shelter the aged have and more needs. It has become of vital importance to help an individual to fight with loneliness, emotional isolation, physic crisis and to regain self-confidence and self-respect. The residents of the nursing home are ill or disabled, majority of whom are widows or widowers and single people. Among them there are those who tend to get into conflicts with relatives or community members and feel as disadvantaged ones or even as victims. The background strategy of social workers and the staff directly working with the residents of the nursing home is to provide help to an individual in the changed living conditions, to assist the elderly to face... [to full text]
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Mangolds, Virginia B. "Health Literacy, Care Transition and Adherence with Discharge Instructions of Patients Discharged to Home from the Emergency Department." eScholarship@UMMS, 2018. https://escholarship.umassmed.edu/gsn_diss/54.
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Purpose: The purpose of this study is to describe the relationship between health literacy, preparedness for discharge, adherence to discharge instructions and difficulty coping after discharge among emergency department patients.
Specific Aims: The Aims of this study were to: (1) describe the variability of health literacy of adult patients in an academic tertiary Emergency Department; (2) describe the relationship between health literacy, care transition, and perceived readiness for discharge on the patient’s adherence to discharge instructions and (3) explore whether health literacy, perceived preparation for discharge and care transition, predicts difficulty coping after discharge.
Framework: Dr. Meleis’s Transitions Theory was used as a framework.
Design: This is a prospective cohort study of adults treated and discharged from the ED. Results: Eighty five percent of the subjects completed the study (n = 132). Subjects satisfied with transition care (P = .025) and who felt more prepared for discharge (P = .035) had less difficulty coping. Subjects more satisfied with care transition were more likely to adhere to medication instructions (P = .029). The higher the satisfaction with discharge preparation, the less likely the subjects were to go to their follow-up appointment (P = 0.051). No associations were found with health literacy.
Conclusion: Satisfaction with care transition during the discharge process and feeling well-prepared are related to less difficulty coping after discharge. Nurses have an opportunity to intervene and enhance the discharge experience. This may contribute to more positive outcomes after being seen in an emergency department.
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Horton, Jeryl Yvette. "Improving Self-Management in Patients With Chronic Conditions." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2489.
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Care Coordination Home Telehealth (CCHT) maintains a positive impact on the delivery of patient care in the primary care clinic at the Department of Veterans Administration Medical Center (VAMC). This quality improvement initiative targets patients with chronic conditions such as diabetes, hypertension, heart failure, and chronic obstructive pulmonary disease. These patient are frequently seen in the emergency room, and are often admitted to the hospital, where they saturate the outpatient clinics' waiting room with multiple walk-ins. CCHT has, to some extent, reduced walk-ins, emergency room visits, and hospitalization while minimizing the strain on access to care at the VAMC. Sustaining self-management skills of veterans with chronic conditions at the VAMC continues to impose challenges. In this project, retrospective data from 95 randomly selected charts reviewed during a 2-year period were used to compare hospitalizations, emergency room visits, and primary care visits. The findings of the study indicate veterans enrolled in Home Telehealth show positive social change. The social change is evidenced by change in behavior patterns, such as maintaining a healthy diet, performing daily physical activity, and compliance with medication administration. Enrolled veterans had better outcomes regarding hospitalization, emergency room visits, and primary care visits. The data highlighted the need for incorporating disease-specific protocols guiding care coordinators at first point of contact with the veteran patient. Following these protocols may enhance communication style that matches the patient's stage of behavioral change with interventions.
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Dyer-Kramer, Theresa. "The Use of a Tool to Assess Long Term Care Surveyor Efficiency and Effectiveness." UNF Digital Commons, 2014. https://digitalcommons.unf.edu/etd/527.
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The quality of care in our nation’s long term care facilities or nursing homes has been a steadfast matter of public policy for the past few decades. In response to research and reports of poor care, the Nursing Home Reform Act (NHRA) was born in 1987. Since that time, additional legislation has been passed to address the same issue. Continued research in early 2000 has shown that although there have been strides toward increasing the quality of care in these facilities, serious care issues continue to exist. As part of NHRA, every long term care facility in this country that accepts payment from the federal government must complete a survey every nine to fifteen months. There are two types of long term care surveys: the traditional and quality indicator survey (QIS). Recent research has documented that both survey processes are flawed. To date, the federal government has no way to monitor whether QIS is meeting its objectives. The purpose of this quality improvement project is to evaluate the use of a tool to assess surveyor efficiency and effectiveness on each survey task in the long term care survey.
A tool was developed to evaluate surveyor efficiency and effectiveness and a pre-pilot was completed in early March of 2014, to test the tool. The outcome of that testing was that data collection was complex; many of the survey tasks were conducted simultaneously making it impossible for one researcher to conduct the evaluation. At the same time, the participating healthcare organization decided that another project took precedence. Although the project never was completed, the evaluation of surveyor efficiency and effectiveness is recommended in further research, as thousands of residents in long term care facilities depend on the survey process to ensure high quality of care.
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Brind'Amour, Katherine. "Maternal and Child Health Home Visiting Evaluations Using Large, Pre-Existing Data Sets." The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1468965739.
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Walker, Lauryn. "Patient-Centered Medical Homes and Hospital Value-Based Purchasing: Investigating Provider Responses to Incentives." VCU Scholars Compass, 2019. https://scholarscompass.vcu.edu/etd/5796.
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Provider incentives are a commonly used policy tool to mold provider behaviors.1 However, while we frequently measure the change in patient outcomes, failure to consistently produce changes in outcomes does not mean that providers are not changing their behavior. This paper focuses on two programs with null or inconsistent quality outcomes to try to identify why such inconsistency occurs. The two programs, both ratified in the Affordable Care Act, are 1) patient-centered medical homes (PCMHs), and 2) the Medicare Hospital Value-Based Purchasing (HVBP) program.
Chapter 1: Using data from the Medical Expenditure Panel survey (MEPS), I match provider characteristic surveys to member experience with care in order to evaluate characteristics key to patient-centered medical homes. I find that patient-perceived patient-centeredness of a practice is not related to the number of PCMH attributes a practice reports. However, some characteristics do play specific and significant roles in patient perception and outcomes. For instance, case management is not only associated with increased patient perception of after-hours access to care, but overall costs were reduced. Interestingly, having after hours clinic hours was more common with practices highly consistent with PCMH criteria, but these hours did not result in decreased emergency department use or cost of care.
Chapter 2: The second provider incentive studied is the Medicare Hospital Value-Based Purchasing Program (HVBP). This program assigns payment adjustments based on performance on a series of rotating quality metrics. To date, changes in patient outcomes cannot be attributed to the program; however, it should not be concluded that hospitals are not responding at all. I identify changes in staffing by provider type as an early indicator of hospital response to payment incentives. Data come from the Virginia Health Information (VHI) Hospital Cost Report, 2010-2017. Using a generalized linear model, I find that when receiving a penalty, hospitals reduce staffing among the most and least expensive personnel (physicians and nursing aides). Hospitals increase nursing and administrative staff following a bonus. These findings are consistent with hospitals responding to incentives both by aiming to improve efficient use of resources and maintain or improve quality of care.
Chapter 3: Finally, I assess potential unintended consequences of the HVBP program, specifically the provision of charity care. Using the VHI cost reports for year 2013 to 2017 with a regression discontinuity model, I find that hospitals receiving a bonus decrease their charity care among the lowest income patients (under 100% federal poverty level (FPL)). Hospitals receiving a penalty tend to reduce charity care among higher income patients (100%-200% FPL). These findings are consistent with two separate responses to the incentives. Hospitals receiving bonuses appear to be cream-skimming healthier, wealthier individuals while hospitals receiving penalties appear to be shifting the focus of their charity care to the most needy, likely in an effort to reduce cost of care levels overall while maintaining their community benefit programs, potentially as a result of goal gradient cognitive bias.
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Fredriksson, Mathias, and Caesar Iseri. "Sjuksköterskors upplevelser av ansvar vid delegering : En empirisk studie." Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-39343.
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Bakgrund: Tidigare forskning visar på en stressig arbetsmiljö för sjuksköterskor med flera komplexa arbetsuppgifter. Behovet av att delegera arbetsuppgifter ökar i och med detta och kraven på att delegera patientsäkert beskrivs som centralt. Den tidigare forskningen ger ingen klar bild över vem som har vilket ansvar i delegeringsfrågan. Syfte: Syftet med examensarbetet var att undersöka sjuksköterskors ansvar vid delegering av hälso- och sjukvårdsinsatser i kommunal verksamhet. Metod: Studien följer en kvalitativ ansats med en innehållsanalys. Insamlingen av data skedde via inspelade semistrukturerade intervjuer. För examensarbetet blev sex sjuksköterskor intervjuade. Resultat: Tre kategorier utformades av resultatet: ansvar gentemot patienten vid delegering, ansvar under delegeringstillfället och ansvar efter utförd delegering. Gemensamt hade informanterna ett standardiserat – webbaserad – delegeringsrutin. Dock fanns det lite till ingen uppföljning på delegeringar. Slutsats: delegeringsprocessen är komplex med oklar ansvarsbild. Sjuksköterskan ansvarar för att patienten i slutänden får god och säker vård även om det är helg, kväll eller sjukdomsfall i personalgruppen.Background: Previous studies show a stressful work environment for nurses with complex job assignments. The demand to delegate job assignments is increasing as an aftermath and the requirement to delegate job assignments with patient safety in mind is described as a central factor. The previous studies gave no clear image of who has the responsibility in delegations. Objectives: The aim of this study was to examine the registered nurses’ experiences of responsibility during delegations. Method: The study has a qualitative approach and is assembled in content analysis. Data has been collected through semi structured interviews. For the study six nurses have been interviewed. Result: The manifested results formed up in three categories: responsibility towards patients when delegating, responsibility during the delegation and responsibility after the delegation. The informants had in common that they were following a standardized web-based delegation routine. Though there was slight to no follow up on the delegations. Conclusion: The delegation process is complex with unclear responsibility. The nurse is responsible for ensuring that the patient receives good and safe care in the end, even if it is weekend, evening or illness in the staff group.
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Ide, Dawn M. "Cited and Underprepared; the Call for Improved Emergency Preparedness in LTC Facilities." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7663.
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This research investigated the connection between the Medicare star rating system and E-tags on emergency preparedness of nursing homes for disasters in Hampton Roads, Virginia. Emergency preparedness in nursing homes has been a topic of growing interest within the past decade. Hampton Roads, Virginia, has a history of natural disasters including hurricanes and flooding, which necessitates a proper and efficient emergency preparedness plan in nursing home facilities. The primary purpose of this research was to review the secondary Centers for Medicare and Medicaid Services (CMS) data regarding the star rating system and E-tag surveys of each of the 37 nursing facilities that were not connected to a hospital or part of a continuing care retirement community to find a correlation, if any, between emergency preparedness and CMS star rating. The theoretical foundation for the research was the diffusions of innovation theory, which addresses innovation that is communicated between members of a team or social group, inclusive of gaining knowledge of an innovation, persuading others to move toward that innovation, team decision making on the innovation, and implementation/confirmation of that innovation. The statistical analysis provided inconclusive answers to research questions. The potential social change from this study is it may inform nursing home administrators of the 4 most frequent E-tag deficiencies found in this research; and their nonlinear relationship to total bed count and variables such as individual Medicare star rating categories so that administrators can apply this new knowledge to their field in general and their facility in particular; to achieve better overall disaster preparedness coordination.
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Holmberg, Nora, and Mikael Toresten. "Tillförlitlig kvalitet – Jämförelse mellan offentlig och privat äldreomsorg." Thesis, Högskolan i Skövde, Institutionen för handel och företagande, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:his:diva-20024.
Full textAbstract:
Under början av 1990-talet infördes reformer som än idag påverkar svensk äldreomsorg. Dessa reformer föranledde till stora förändringar i den offentliga sektorn, där privatiseringen av offentliga tjänster är en del av resultatet. I nästan tre decennier har resultatet av dessa reformer varit väl omdiskuterade i både politiska sammanhang och samhället, där äldreomsorgen är en av de stora reformerna som diskuteras. Föreliggande studie jämför och analyserar tillförlitlig kvalitet på given vård i äldreomsorgen mellan den offentliga och privata sektorn eftersom den privata sektorn ibland har ett vinstintresse, vilket den offentliga sektorn saknar. Syftet med studien var att jämföra och analysera hur chefer uppfattar möjligheten att ge tillförlitlig kvalitet i verksamheten. Arbetet i den dagliga verksamheten utförs av chefer och medarbetare tillsammans, vilket föranledde att det i studien intervjuades åtta chefer på äldreboenden i Sverige, där fyra chefer från respektive offentlig eller privat given äldrevård utgjorde studiens empiriska material. Intervjufrågorna var konstruerade utifrån studiens analysmodell som bygger på karaktäristiska egenskaper för organisationer med hög tillförlitlighet. Föreliggande studie visar att cheferna i både den offentliga och privata sektorn uppfattar, utifrån de förutsättningar som finns i äldreomsorgen, möjlighet till tillförlitlig kvalitet. Dock visar resultatet av studien att det finns brister i den tillförlitliga kvaliteten. Studiens vetenskapliga bidrag visar på kvaliteten utifrån de förutsättningar som chefer har att ge en tillförlitlig kvalitet i äldreomsorgen.During the start of the 1990´s reforms were introduced that to this day affect Swedish elderly care. These reforms brought forth large alterations in the public sector where in multiple, previously public services were privatized. In the following three decades have these reforms been regularly discussed in both political contexts and society, where the reforms of the elderly care have been prominent. This study compares and analyze reliable quality of administrated care of elderly between the public and private sectors, because of the private sector´s common profit orientation, which the public sector does not have. The purpose of this study was to compare and analyze how management perceive the opportunity to give reliable quality within the organization. Operational labor is performed by both management and coworkers together which resulted in eight managers within the Swedish elderly care being interviewed wherein four worked in the public sector and private, respectively. These interviews became the empirical basis for the study. The interview questions were constructed using the studies analytical model which is based on characteristic properties within organization with high reliability. The result of this study shows that managers in both the public and private sectors perceive the possibility of reliable quality based on the conditions that exist in elderly care. However, the results of the study show that there are shortcomings in the reliable quality. The study´s scientific contribution indicates the quality based on the conditions that managers have to provide a reliable quality in elderly care.
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"The vanishing nursing home administrator: Stress and intent to leave." CAPELLA UNIVERSITY, 2009. http://pqdtopen.proquest.com/#viewpdf?dispub=3359575.
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Kobuck, Shelley. "Moral Courage: A Requirement for Ethical Decision Making in Nursing Home Leadership." 2015. http://digital.library.duq.edu/u?/etd,197221.
Full textAbstract:
Moral courage will no longer be an option for Nursing Home Administrators (NHA) to lead ethically with the projections for the future needs of healthcare services and the governmental involvement in containing the costs of care in the United States. The estimated increase in the 65 year and older population over the next 40 years and the accompanying impacts necessitate that healthcare will need to make significant changes from the care and services that currently exist. This growth in population of older adults will also be coupled with increased disability and declining resources. Due to these trends, persons in leadership positions in nursing homes are going to be increasingly faced with balancing competing needs and the equitable distribution of resources. For a leader to be able to function effectively within this healthcare environment requires moral courage in making the difficult decisions that are being presented. Healthcare has always been posed with ethical dilemmas at times but the rapid changes and increases in need will not allow for occasional situations to arise that necessitate difficult decisions. These will become the norm for the daily operations for care delivery and the leadership of nursing homes must possess the ability to act courageously as an advocate for the patients and residents within the limited resources.
<br>Like most other healthcare professions, NHAs are not proficiently trained to think in ethical terms, particularly on a day-to-day basis. In addition, there are inadequate ethical guidelines in the professional associations and licensing standards for administrators. Many NHAs do not possess the skills, knowledge, or character to enact moral courage. Without moral courage the residents and patients will not have the ethical representation by the leadership which poses a concern for upholding the best interests of the residents and patients who deserve to be treated with dignity and respect as valued and unique individuals. To think ethically requires education and skill development if not already intrinsic to the person. Ethical actions must follow through the decision making process and moral courage is the conduit for ethical leadership for the Nursing Home Administrator.
<br>To understand these ethical concepts within the healthcare realm of nursing homes and the leadership perspective is to first review the background for this need for moral courage. The heart of holding a leadership position in any healthcare organization is to manage all operational aspects that provide and support the care of the patients and residents. The historical review of healthcare in the U.S. will look at the progression to the current implementation of healthcare reform which is necessitating decisions surrounding competing needs. This evolving healthcare situation is ripening challenges for moral courage in the forms of limited education in ethics, conflicts of interest, and resource allocation. The typical scenario for ethical dilemmas has been deciding between patient and financial benefits however decisions will increasingly involve choices among competing patient needs when each patient could benefit. Past examples are summarized which outline poor ethical choices among healthcare leaders which will further support an increasing need for moral courage in decision making.
<br>In healthcare moral courage is rooted in providing care to patients in a caring manner. The relationship between moral courage and patient care will be assessed by defining morality and courage. Courage will be further explored from a philosophical perspective within its defining qualities of gaining insight, being motivated to act with courage, and to experience a need to help another which connects it very appropriately to care. The provision of care is the core function of nursing homes which can get lost or forgotten within the organizational complexities. The NHAs who possess the attribute of courage can utilize it through acts of caring. This caring nature can be exhibited by going beyond the self for the leadership and recognizing the sanctity and dignity of all human life which can be displayed in morally courageous decisions. For NHAs to act ethically, they must recognize patients as persons first who are in need of care. To come from the point of the patient is the foundation for decisions, ethically, in which the leader must maintain a human connection. The ethics of care brings together several points that are paramount to ethical decision making for the leadership. This theory includes basic principles for moral development and the relationships between the patients and the caregivers. Although the ethics of care is relationship-based, ethical leadership is still bound to upholding the rights of the patients which are supported by traditional ethical theories based in justice. The combination of the relationships with the patients, and being an advocate for their rights, aligns moral courage with caring actions.
<br>Moral courage is the core of ethical leadership in nursing homes and starts with a review of determinates that contribute to the NHA leading morally. While there are contributors to strong ethical leadership such as values, competencies, emotional awareness, and accountability, there are also challenges that can lead to moral compromise. There are a variety of leadership styles which will be discussed along with secondary distinctions formulated on traits, which will offer differing approaches in enacting moral courage. Some styles lend themselves more readily to promoting an ethically grounded nursing home. Several models for ethical decision making will be explained which can be applied to morally courageous resolutions.
<br>The actions and decisions of the leadership of all organizations define the ethical climate and their morally courageous decisions set the expectations for the rest of the organization to follow. The combination of written guidelines and the actions of the leadership flow into a level of trust. The nature of the ethical climate will be apparent through both internal and external means and in the value placed on the decisions surrounding quality of care and safety within nursing homes. Compliance and ethics programs serve as another level of support for providing positive ethical environments. These programs can offer nursing homes a constant mode of checks and balances to insure that an atmosphere is maintained which promotes moral courage throughout the organization.
<br>A barrier for leaders to be effective in making decisions requiring moral courage is the need to comprehend and develop a level of competency to do so. Several strategies will be covered that include ethics education, leadership mentoring, and case study reviews that can be utilized for training and development purposes. Also models for assessing and carrying out decisions based in moral courage will be explained as other resources for leadership development. The author also offers a model of moral courage for consideration.
<br>For the future of nursing homes moral courage will become a requirement in executive leadership for ethical decision making in the best interests of patient care. Given the demographic changes that are evolving along with the anticipated growth and resource allocation, the challenges surrounding ethical dilemmas will become increasingly problematic. Leaders will need to be tethered to a virtuous foundation of courage and care that never loses sight of the patient as person with the sanctity and dignity in all human life. As decisions are navigated through moral courage, which is translated through behaviors and actions of the NHA, they will necessitate that the leadership have the ability to operate beyond self-interests. Where the competencies do not exist there will be a need for leadership development and an even greater need for strength of character among the highest levels of healthcare organizations to establish positive ethical climates. The NHA leaders beginning now and into the future will need to balance the care requirements against resource limitations and financial viability in a more demanding way than ever before in this ever-changing healthcare delivery system.McAnulty College and Graduate School of Liberal Arts;
Health Care Ethics
PhD;
Dissertation;
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McCarthy, Jennifer. "The light shines in the darkness : a qualitative exploration of administrator satisfaction in an increasingly dissatisfying industry." Thesis, 2004. http://hdl.handle.net/1957/28966.
Full textAbstract:
PURPOSE-Administrators of nursing homes are turning over at very high rates in the present
industry. With the growth of older populations needing skilled nursing care, this
presents a risk to the needs of the elderly. Satisfaction and turnover have been
correlated in the literature. The purpose of this qualitative study was to explore
dimensions of satisfaction and dissatisfaction among nursing home administrators in
order to ascertain constructs potentially contributing to dissatisfaction in the industry.
METHODS-Informational letters were mailed to all licensed administrators in the state (N=143)
who were then randomized to receive follow-up invitational phone calls to join the
study. Those interested in participating were asked a few short screening questions
about their tenures in the industry and overall perceptions of satisfaction. Interested
participants were then divided into 3 different strata based on their tenures. Purposive
sampling informed the choices of participants and selected 10 from each of the
shortest, longest, and most dynamic tenures. Interviews occurred on nursing home
sites around Oregon. Grounded theory was used in a priori analysis by means of a
coding paradigm in order to allow emergent data to reveal substantive categories in a
theoretically directed pattern of coding, contrasting, verifying, and eventually
grounding new theory in data.
FINDINGS-Allowing the data to emerge in analysis of satisfaction and dissatisfaction revealed
two corresponding core categories, Constraints to the Job and Meaningful Work.
Constraints to the Job included 4 categories: Bureaucratic Constraints, Budgetary
Constraints, Personnel Constraints, and Ethical Constraints. Meaningful Work
included Working Conditions and Meaningful Interiors. As dissatisfaction and
satisfaction were further compared and verified, theory grounded in data emerged and
revealed that constraints to the job obstruct an administrator's autonomy, which in turn
impedes the ability to engage in meaningful work and contributes to dissatisfaction.
CONCLUSIONS-While constructs of dissatisfaction emerged, administrators on the whole revealed high
satisfaction with their positions. Future studies should concentrate on the bureaucratic
constraints to the job as these constraints were perceived as extremely dissatisfying
and hold political implications for state and corporate policies.Graduation date: 2005
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Bjarnadottir, Ragnhildur I. "Assessment and Documentation of Sexual Orientation and Gender Identity in Home Healthcare." Thesis, 2016. https://doi.org/10.7916/D8ZW1M3V.
Full textAbstract:
This dissertation examines the assessment and documentation of sexual orientation and gender identity in the home healthcare setting, specifically patient and nurse perceptions of such data collection, as well as what is documented in nurses’ narrative notes about patients’ sexual orientation and gender identity. Chapter One describes the problem of health disparities among lesbian, gay, bisexual and transgender (LGBT) patients and how lack of documentation contributes to this problem. In Chapter Two, an integrated review of the literature on patients’ attitudes and perceptions related to the collection of information about sexual orientation and gender identity in the healthcare setting is reported. In Chapter Three, a qualitative study to determine nurses’ experiences, attitudes, and perceptions related to collecting information about sexual orientation and gender identity in the home healthcare setting is reported, and emergent barriers and facilitators discussed. In Chapter Four, a data mining study to examine what is documented about sexual orientation and gender identity in narrative home care nurses’ notes in an electronic health record is described. Finally, in Chapter Five, the findings of the three studies are summarized, overarching conclusions reported and implications for policy, practice and research are discussed.
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Chen, Li. "Service quality and customer satisfaction: a case study of nursing homes in Beijing." Doctoral thesis, 2019. http://hdl.handle.net/10071/19795.
Full textAbstract:
With the rapid development of China’s economy and ever-increasing life expectancy of the Chinese people, medium and high-end elderly care service is seeing a significant surge. Institutions providing such services, in their effort to obtain a competitive edge, have been eager to borrow a page from counterparts in western developed countries in terms of improving service management quality. However, given the differences in market attributes between China and foreign countries, management models in western countries cannot be entirely copied into China. In fact, despite the fast improvement in medical service and quality level in Chinese elderly care institutions, non-medical technology service quality management is not improving as fast and ideally. Relations between consumer groups of different segments and non-medical technology service quality management of the same nursery and consumer satisfaction have become a key issue attracting the attention of players in China medium and high-end elderly care service market.
With three K-brand Nursing Homes in Beijing as research objects, a questionnaire survey is conducted to explore the relationship between non-medical technical service quality, consumer satisfaction, and market segmentation. 355 valid questionnaires were retrieved. On the basis of literature review and field survey, this study adjusts the items of widely-used SERVQUAL and uses standardized presentation and interaction to describe consumer perceived service quality. Based on the research hypothesis and conceptual model to be tested, this study applies a structural equation model, uses model fitting index (CFI, TLI, RMSEA, and SRMR) to assess the fitting degree of actual data structure and theoretical structure, and estimates and tests the path coefficient in the model (hypotheses).
The research shows that standardized presentation and interaction are positively correlated with consumer satisfaction when dividing the market according to individual characteristics and nursing homes; all individual characteristics index have an impact on the perception of standardized presentation, some individual characteristics index have an impact on the perception of interaction, and some individual characteristics have an impact on consumer satisfaction; and different nursing homes have an impact on consumer perceived service quality and consumer satisfaction; standardized presentation has a direct impact on consumer satisfaction, interaction has a direct impact on consumer satisfaction, standardized presentation has an indirect impact on consumer satisfaction through the direct impact of interaction on consumer satisfaction.
This study contributes to a better understanding of service quality management and provides a new theoretical basis and methods for improving consumer satisfaction of nursing homes in China.Com o rápido desenvolvimento da economia Chinesa e o aumento constante da esperança de vida à nascença da população Chinesa, a procura de bens de cuidados para a terceira idade por parte da classe média e alta tem crescido de forma significativa. As instituições que prestam tais serviços, de modo a manterem-se competitivas, têm procurado melhorar as formas de gestão e prestação de serviços por adaptação de práticas ocidentais. Contudo, dadas as diferenças entre os dois mercados, os modelos de gestão ocidentais têm que ser adaptados ao mercado chinês. De facto, apesar do rápido crescimento dos serviços de saúde e qualidade do serviço prestado nas instituições Chinesas especializadas no segmento sénior, a melhoria da qualidade dos serviços de base não médica não tem acompanhado o mesmo ritmo. Em particular, a relação entre consumidores de diferentes segmentos, gestão da qualidade da componente não médica de prestação de serviço e a satisfação dos utilizadores têm atraído a atenção dos prestadores de serviços no mercado Chinês para o segmento médio e elevado. Este estudo centra-se nos três lares da K-brand Nursing Homes em Pequim, sendo realizado um estudo por inquérito de modo a explorar a relação entre a qualidade do serviço prestado em termos de tecnologia não-médica, a satisfação dos utilizadores do serviço e a própria segmentação do mercado. O estudo empírico teve por base uma amostra de 355 observações após validação. Tendo por base a literatura e os dados, os itens da escala SERVQUAL foram ajustados e organizados em duas dimensões da qualidade do serviço percebida pelo utilizador: estandardização da apresentação e interação. Tendo por base as hipóteses de estudo e o modelo concetual, aplicou-se um modelo de equações estruturais, utilizando indicadores de ajustamento (CFI, TLI, RMSEA e SRMR) para medir a qualidade do ajustamento do modelo aos dados e estimar as relações estruturais no modelo (hipóteses). Os resultados mostram que a estandardização da apresentação e a interação estão positivamente correlacionadas com a satisfação dos utilizadores quando as características dos utilizadores e dos lares são tidas em consideração; todas as características dos pacientes consideradas neste estudo influenciam a perceção da estandardização da apresentação, algumas têm impacto na interação, e algumas influenciam a satisfação dos pacientes; a natureza do lar tem impacto na perceção do serviço prestado e na satisfação do paciente; a estandardização da apresentação tem um efeito direto na satisfação do paciente, interação tem um efeito direto na satisfação dos pacientes, e a estandardização da apresentação tem um efeito indireto na satisfação dos pacientes via a interação. Este estudo contribui para uma melhor compreensão da gestão da qualidade do serviço prestado, bem como com novas bases teóricas e métodos para melhor compreender a satisfação dos utilizadores de lares de terceira idade na China.