Changing the Culture of Nursing Homes

Johnson, MaryAnne

doi:10.1001/archinternmed.2009.550

Cited by 23 publications

(17 citation statements)

References 9 publications

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“…In US nursing homes, physicians have been called "missing in action" because they are frequently not there when families visit [24,165]. Having a dedicated physician who knows the patient and family well is crucial for coordinating care and providing guidance [24,29,[165][166][167][168]. Other members of the multi-disciplinary team of physicians, nurses, nurse practitioners, and social workers may also fulfill a coordination role, especially when specifically trained in palliative care in dementia patients.…”

Section: Continuity Of Carementioning

confidence: 99%

Dying with Dementia: What We Know after More than a Decade of Research

Steen

2010

JAD

226

177

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Abstract. Death with dementia is increasingly common. Although prognostication is difficult, it is an incurable life-limiting illness for which palliative care for the patient is often appropriate. Dementia patients are otherwise at risk of overtreatment with burdensome and possibly non-beneficial interventions and undertreatment of symptoms. Although recent studies indicate encouraging trends of improved palliative care, little evidence supports effectiveness of specific treatments. As of January 2010, at least 45 studies, almost all performed after 2000, have reported on treatment, comfort, symptom burden, and families' satisfaction with care. Over half (25; 56%) of these studies were in US settings, and most were small or retrospective. Few randomized trials and prospective observational studies have been performed so far, but several promising studies have been completed recently or are underway in various countries. Guidelines for care and treatment, still mostly consensus-based, support the benefits of advance care planning, continuity of care, and family and practitioner education. Assessment tools for pain, prognosis, and family evaluations of care have been developed and some have been shown to be effective in clinical practice. With increasing numbers of well-designed, large-scale studies, research in the next decade may result in better evidence-based guidelines and practice.

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Section: Continuity Of Carementioning

confidence: 99%

Dying with Dementia: What We Know after More than a Decade of Research

Steen

2010

JAD

226

177

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“…Residential aged care facilities (RACF) provide an optimal learning experience for university student placements as it allows students to work with the complex needs of the elderly, thus providing an ideal environment to create an interprofessional learning experience (Halcomb et al 2009;Johnson 2010;Kanter 2012;Lucas et al 2013aLucas et al , 2013b. Although several studies focus on the student experience and attitudes towards interprofessional learning across many aged care facilities (Ponzer et al 2004;Hertweck et al 2012;Lie et al 2013;Lucas et al 2013aLucas et al , 2013b, there is very limited evidence around the perceived benefits and barriers to the residents and staff involved in interprofessional programs.…”

Section: Introductionmentioning

confidence: 99%

Interprofessional learning in residential aged care: providing optimal care for residents

Seaman¹,

Bulsara

Saunders

2015

Aust. J. Prim. Health

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Abstract. Since 2010, a residential aged care provider has been in collaboration with universities in Western Australia to deliver an interprofessional education (IPE) program in residential aged care facilities. The program takes place within a residential aged care setting where university student placements from seven disciplines are integrated into a dynamic interdisciplinary team approach for care delivery. This approach provides the opportunity for two or more professionals to learn together to provide optimal care for residents. In 2012, an extensive research evaluation was performed to demonstrate, among other outcomes, the benefits to the residents and staff involved in the program. Residents, family members and staff from a residential aged care facility were invited to participate in the mixed methods evaluation. The qualitative aspects were digitally recorded, transcribed and thematically analysed. SPSS (SPSS Inc., Chicago, IL, USA) was used to analyse the quantitative data. All were exceptionally satisfied with the IPE program.

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“…Insufficient medical staff presence can lead to impaired processes of care and troubling resident outcomes, such as undertreated symptoms and unnecessary re-hospitalizations (Intrator et al, 2004; Tija et al, 2009; Johnson 2010). In this paper we offer the “Nursing Home Medical Staff Involvement Model,” to help clarify and advance theory and its application in gerontological research (Cutchin 2009), and to focus on a range of activities in which a medical staff member is, or could be, professionally engaged as a participant in various nursing home (NH) activities, including communication with residents, family members, or other NH staff.…”

Section: Introduction: Medical Staff Involvement In Nursing Homesmentioning

confidence: 99%

“…We define medical staff to include physicians (MDs) as well as nurse practitioners (NPs) and physician assistants (PAs) to underscore NPs’ and PAs’ important roles in assessing and managing medically complex residents (Caprio 2006, Johnson 2010). NHs are health care facilities bound by federal and state health care policy (Dimant, 2003; Winn et al, 2004).…”

Section: Introduction: Medical Staff Involvement In Nursing Homesmentioning

confidence: 99%

Medical Staff Involvement in Nursing Homes

et al. 2012

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Medical staff (physicians, nurse practitioners, physicians’ assistants) involvement in nursing homes (NH) is limited by professional guidelines, government policies, regulations, and reimbursements, creating bureaucratic burden. The conceptual NH Medical Staff Involvement Model, based on our mixed methods research, applies the Donabedian structure-process-outcomes framework to the NH identifying measures for a coordinated research agenda. Quantitative surveys and qualitative interviews conducted with medical directors, administrators and directors of nursing, other experts, residents and family members and Minimum Data Set, the Online Certification and Reporting System and Medicare Part B claims data related to NH structure, process and outcomes were analyzed. NH control of medical staff, or structure, affects medical staff involvement in care processes and is associated with better outcomes (e.g. symptom management, appropriate transitions, satisfaction). The Model identifies measures clarifying the impact of NH medical staff involvement on care processes and resident outcomes and has strong potential to inform regulatory policies.

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Changing the Culture of Nursing Homes

Cited by 23 publications

References 9 publications

Dying with Dementia: What We Know after More than a Decade of Research

Dying with Dementia: What We Know after More than a Decade of Research

Interprofessional learning in residential aged care: providing optimal care for residents

Medical Staff Involvement in Nursing Homes

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