Developing Individualized Care in Nursing Homes

Abstract

Despite recent attention devoted to the development of individualized care in nursing homes, empirical research assessing changes in practice is quite limited, and very few studies have explored specifically the experiences and perceptions of certified nurse aides (CNAs). This study reports findings from a comparative analysis conducted on a data set including quantitative and qualitative data from CNAs (N = 289) and nurses in Connecticut (N = 245). Measures of obstacles to individualized care and needs for future supports were explored. A number of significant differences in perceptions of obstacles to providing individualized care were found. The nurses were significantly more likely to identify the following impediments to change: cost (p < .0001), concepts not integrated into work (p < .0001), lack of administrative support (p < .10), and staff attitudes (p < .10). The CNAs were significantly more likely to report inadequate staffing (p < .001), lack of interdisciplinary teams (p < .001), and resident and family attitudes (p < .01) as problematic. These findings suggest substantial discordance among nurses and CNAs on a number of important issues surrounding individualized care. Such disparate perceptions pose challenges to nursing homes committed to the implementation of individualized care alternatives. Successful approaches must consider the various vantage points of caregivers and administrators.

Pain Assessment Practices With Nursing Home Residents

“…Two studies found that, in the absence of adequate staffing, caregivers often cut corners in care delivery (Bowers & Becker, 1992;Riggs & Rantz, 2001). The constrained fiscal resources in nursing homes and the regulated environment may also prevent optimal practice patterns (Aday & Andersen, 1974;Schnelle, Cruise, Rahman, & Ouslander, 1998) while encouraging a rigid, static environment with high staff turnover, poor communication patterns, and difficult nurse recruitment (Caudill, & Patrick, 1989;Chopoorian, 1986;Cohen-Mansfield, 1997;Walker, Porter, Grunman, & Michalski, 1998).…”