The Nature of Staff - Family Interactions in Nursing Homes: Staff Perceptions.

Each year thousands of older adults are admitted to nursing homes. Following admission, nursing home staff and family members must interact and communicate with each other. This study examined relationship and communication patterns between nursing home staff members and family members of nursing home residents, as part of a larger multi-method comparative case study.

Development and implementation of the TrAC (Tracking After-hours Calls) database: a tool to collect longitudinal data on after-hours telephone calls in long-term care.

Introduction: Effective telephone communication between long-term care (LTC) nurses and physicians is an integral part of high-quality care, yet little is known about this key aspect of LTC practice. The authors describe the development and implementation of the TrAC (Tracking After-hours Calls) system, an electronic database designed to collect longitudinal data on after-hours telephone calls from LTC facilities.

Development: A relational database was developed to systematically record key characteristics of calls received from LTC facilities, including the date, time, location and reason for each call (new symptom/event, lab or x-ray report, verify admission orders, order clarification, other).

"The Golden Rule": Only a starting point for quality care.

The Golden Rule guides people to choose for others what they would choose for themselves. The Golden Rule is often described as 'putting yourself in someone else's shoes', or 'Do unto others as you would have them do unto you'(Baumrin 2004). The viewpoint held in the Golden Rule is noted in all the major world religions and cultures, suggesting that this may be an important moral truth (Cunningham 1998).

Exit interview-consultation for research validation and dissemination.

Dissemination of research findings to practice and maintenance of rigor and validity in qualitative research are continuing challenges for nurse researchers. Using three nursing home case studies as examples, this article describes how exit interview-consultation was used as (a) a validation strategy and (b) a rapid research dissemination tool that is particularly useful for nursing systems research. Through an exit interview-consultation method, researchers validated inferences made from qualitative and quantitative data collected in three comprehensive nursing home case studies that examined nursing management practices.

Connection, regulation, and care plan innovation: a case study of four nursing homes.

We describe how connections among nursing home staff impact the care planning process using a complexity science framework. We completed six-month case studies of four nursing homes. Field observations (n = 274), shadowing encounters (n = 69), and in-depth interviews (n = 122) of 390 staff at all levels were conducted.

Inter-disciplinary focus groups on telephone medicine: a quality improvement initiative.

Objective: To identify opportunities for quality improvement in long-term care telephone medicine using a model of interdisciplinary focus groups.

Design: Descriptive pilot project.

Setting: Extended Care and Rehabilitation Center (ECRC), Durham VA Medical Center, Durham, North Carolina.

MDS coordinator relationships and nursing home care processes.

This study describes how Minimum Data Set (MDS) coordinators' relationship patterns influence nursing home care processes. MDS coordinators interact with nursing home staff to coordinate resident assessment and care planning, but little is known about how they enact this role or influence particular care processes beyond paper compliance. Guided by complexity science and using two nursing home case studies, the authors describe MDS coordinators' relationship patterns by assessing the extent to which they used and fostered good connections, new information flow, and cognitive diversity.

Patterns of medical and nursing staff communication in nursing homes: implications and insights from complexity science.

Complexity science teaches that relationships among health care providers are key to our understanding of how quality care emerges. The authors sought to compare the effects of differing patterns of medicine-nursing communication on the quality of information flow, cognitive diversity, self-organization, and innovation in nursing homes. Two facilities participated in 6-month case studies using field observations, shadowing, and depth interviews.

Urinary incontinence strategies for frail elderly women.

Among the majority of frail older women, urinary incontinence has not been adequately assessed or treated, with resultant negative impact on quality of life. An assessment and intervention model based on type of incontinence, evidence-based interventions, and the influence of patient preference and capacity to carry out interventions are described.

Complexity theory: a long-term care specialty practice exemplar for the education of advanced practice nurses.

This clinical exemplar highlights how an academic clinical practice supported gerontological nursing students as they learned evidence-based approaches to managing complex geriatric syndromes in long-term care. Urinary incontinence (UI), which occurs in more than two thirds of nursing home residents, was the focus of the faculty practice. Advanced practice nursing skills developed by students included advanced physical assessment and diagnostic reasoning techniques, critical appraisal of the scientific evidence for UI management, and the ability to teach evidence-based approaches to UI care to bedside nursing staff.

Promoting social continence: products and devices in the management of urinary incontinence.

Urinary incontinence (UI) is a prevalent problem occurring in men and women across the lifespan. Technologic innovations have provided individuals with incontinence and caregivers with an array of options for achieving social continence. Even when UI cannot be completely cured, it can always be managed with products, skin care regimens, occlusive or drainage devices and toileting equipment to ensure optimal skin integrity, odorless urine containment, social independence, comfort, and freedom of movement.

Bladder management in adult care homes. Review of a program in North Carolina.

In North Carolina there are approximately 34,000 residents in adult care homes (ACHs). Approximately 40% of these residents have urinary incontinence, and others require assistance with toileting. High prevalence of cognitive impairment, few licensed staff, and low staff-to-resident ratios in ACHs make behavioral techniques used in community-dwelling populations and toileting programs used in nursing homes inappropriate for these residents.