Nurse staffing levels: impact of organizational characteristics and registered nurse supply.

Objective: To assess the impact of nurse supply in the geographic areas surrounding hospitals on staffing levels in hospital units, while taking into account other factors that influence nurse staffing.

Data Sources: Data regarding 279 patient care units, in 47 randomly selected community hospitals located in 11 clusters in the United States, were obtained directly from the hospitals from the U.S.

Determining mild, moderate, and severe pain equivalency across pain-intensity tools in nursing home residents.

Older adults in nursing homes experience pain that is often underassessed and undertreated. Visual analog pain-intensity scales, recommended for widespread use in adults, do not work well in the older adult population. A variety of other tools are in use, including the Verbal Descriptor Scale, the Faces Pain Scale (FPS), and the Numeric Rating Scale.

Translation research in long-term care: improving pain management in nursing homes.

Background: Pain prevalence in nursing homes remains high, with multiple resident, staff, and physician barriers presenting serious challenges to its improvement.

Aims: The study aims were to (1) develop and test a multifaceted, culturally competent intervention to improve nursing home pain practices; (2) improve staff, resident, and physician knowledge and attitudes about pain and its management; (3) improve actual pain practices in nursing homes; and (4) improve nursing home policies and procedures related to pain.

Methods: A multifaceted, culturally competent intervention was developed and tested in six Colorado nursing homes, with another six nursing homes serving as control sites.

Changes in clinician ability to assess risk and help patients determine the need for hiv testing: a comparison of three teaching methods.

An estimated one of four people with HIV in the United States do not know they have the infection. The Centers for Disease Control and Prevention encourages HIV testing in clinical settings, but there is evidence that this is not done on a regular basis. The purposes of this study were to (a) compare two less traditional teaching methods with a classroom method to determine whether the less traditional methods resulted in greater improvement of clinician knowledge, skill, and willingness to perform HIV risk assessment as the basis for recommending HIV testing; and (b) find out whether there were significant differences in convenience, cost, learner preference, or learner acceptance that would make one method more desirable than the others.

Nursing home resident barriers to effective pain management: why nursing home residents may not seek pain medication.

Objectives: Multiple barriers to effective pain management are present in the nursing home setting. The purpose of this analysis was to determine the extent to which residents in pain declined to request pain medication from the staff, and the reasons provided by the residents to explain this behavior.

Design: Every 3 months, a 20% sample of residents in 12 nursing homes was administered a short pain interview, then observed for pain indicators.

Assessing the appropriateness of pain medication prescribing practices in nursing homes.

Objectives: To test a tool for screening the quality of nursing home (NH) pain medication prescribing.

Design: Validity and reliability of measurement tool developed for a pre/postintervention with untreated comparison group.

Setting: Six treatment NHs and six comparison NHs in rural and urban Colorado.

Measuring pain intensity in nursing home residents.

Assessing pain intensity in nursing home residents remains a challenge. As part of a multifaceted intervention study to improve pain practices in nursing homes, quarterly pain assessments were conducted in 12 Colorado nursing homes. Residents who reported pain or discomfort of any kind in the past 24 hours were asked to choose one of three pain intensity scales to quantify their current and highest level of pain intensity.

Linking nursing home working conditions to organizational performance.

Exploring selected working conditions and performance in nursing homes suggests that high and low performers can be determined based on both quantitative and qualitative findings.

Nursing home culture: a critical component in sustained improvement.

In the third in a series of articles exploring working conditions and quality improvement in nursing homes, 31 nursing homes were surveyed using an adaptation of the Competing Values Framework (CVF) Organizational Assessment. The CVF provides information about the organizational culture through describing dominant perceived values, distribution of values across organizational characteristics, and orientation of values toward flexibility. Staff reported a dominant group culture, reflecting a family and team orientation within their settings.

Nursing home resident barriers to effective pain management: why nursing home residents may not seek pain medication.

Objectives: Multiple barriers to effective pain management are present in the nursing home setting. The purpose of this analysis was to determine the extent to which residents in pain declined to request pain medication from the staff, and the reasons provided by the residents to explain this behavior.

Design: Every 3 months, a 20% sample of residents in 12 nursing homes was administered a short pain interview, then observed for pain indicators.

Assessing nursing homes' capacity to create and sustain improvement.

Nursing home leadership and staff in 32 nursing homes were surveyed using an adaptation of Shortell's Organization and Management Survey. An earlier psychometric assessment of Shortell's communication and leadership scales raised concerns about the reliability of these scales in the nursing home setting. Exploratory factor analysis was performed to determine if another scale structure should be considered.

Improving nursing home staff knowledge and attitudes about pain.

Purpose: Effective pain management remains a serious problem in the nursing home setting. Barriers to achieving optimal pain practices include staff knowledge deficits, biases, and attitudes that influence assessment and management of the residents' pain.

Design And Methods: Twelve nursing homes participated in this intervention study: six treatment homes and six control homes, divided evenly between urban and rural locations.

Exploring nursing home staff's perceptions of communication and leadership to facilitate quality improvement.

Leadership and clinical staff were surveyed to explore communication and leadership in nursing homes. Registered nurses and other professionals perceived communication as better than their nursing colleagues did. Overall, results suggest all factors of communication could improve.

Patient and staff safety: voluntary reporting.

Central to efforts to assure the quality of patient care in hospitals is having accurate data about quality and patient problems. The purpose was to describe the reporting rates of medication administration errors (MAE), patient falls, and occupational injuries. A questionnaire was distributed to staff nurses (N = 1105 respondents) in a national sample of 25 hospitals.

Hard-to-reach providers: targeted HIV education by the national AIDS education and training centers.

A national system of AIDS Education and Training Centers (AETCs) has received federal funding since 1987 to provide education to health care personnel (HCP) about HIV infection. The purpose of this study is to describe how AETC program personnel define and recognize HCP who are hard to reach and educate about HIV and to clarify the issues that make providers hard to reach. Twenty-three semistructured telephone interviews were used to collect data from AETC faculty and staff.

Physiologic correlates of comfort in healthy children.

Pain assessment is particularly challenging when children are unable or unwilling to provide a self-report. Although clinicians frequently use vital signs as an adjunct to pain assessment, little evidence exists to support this practice. The purpose of this study was to explore the ability of selected physiologic variables (peripheral skin temperature, heart rate, skin conductance activity [SCA], respiratory rate, electromyogram [EMG] of the frontalis and right forearm muscles, and systolic and diastolic blood pressure [BP]) to detect changes in children's autonomic arousal from baseline.

Outcomes of therapeutic massage for hospitalized cancer patients.

Purpose: To examine the effects of therapeutic massage on perception of pain, subjective sleep quality, symptom distress, and anxiety in patients hospitalized for treatment of cancer.

Organizing Construct: Rogers' Science of Unitary Human Beings and Watson's theory of human caring.

Methods: Quasiexperimental.