Measuring Work Environment and Performance in Nursing Homes

Temkin‐Greener, Helena; Zheng, Nan; Katz, Paul R.; Zhao, Hongwei; Mukamel, Dana B.

doi:10.1097/mlr.0b013e318190cfd3

Cited by 51 publications

(70 citation statements)

References 33 publications

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“…For example, more BRNs in the mix of staff might lead to better teamwork and communication, that could result in better QoC [17, 50]. Other examples of work processes BRNs might have influence on are the coordination of care [51], and the collaboration between nursing staff and nursing home medical specialists or allied health professionals [52]. In addition, BRNs might indirectly add value to QoC in LTCFs by acting as a clinical leader and coach for other nursing staff [53].…”

Section: Discussionmentioning

confidence: 99%

Relationship between the presence of baccalaureate-educated RNs and quality of care: a cross-sectional study in Dutch long-term care facilities

Backhaus

Rossum

Verbeek

et al. 2017

BMC Health Serv Res

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BackgroundRecent evidence suggests that an increase in baccalaureate-educated registered nurses (BRNs) leads to better quality of care in hospitals. For geriatric long-term care facilities such as nursing homes, this relationship is less clear. Most studies assessing the relationship between nurse staffing and quality of care in long-term care facilities are US-based, and only a few have focused on the unique contribution of registered nurses. In this study, we focus on BRNs, as they are expected to serve as role models and change agents, while little is known about their unique contribution to quality of care in long-term care facilities.MethodsWe conducted a cross-sectional study among 282 wards and 6,145 residents from 95 Dutch long-term care facilities. The relationship between the presence of BRNs in wards and quality of care was assessed, controlling for background characteristics, i.e. ward size, and residents’ age, gender, length of stay, comorbidities, and care dependency status. Multilevel logistic regression analyses, using a generalized estimating equation approach, were performed.Results57% of the wards employed BRNs. In these wards, the BRNs delivered on average 4.8 min of care per resident per day. Among residents living in somatic wards that employed BRNs, the probability of experiencing a fall (odds ratio 1.44; 95% CI 1.06-1.96) and receiving antipsychotic drugs (odds ratio 2.15; 95% CI 1.66-2.78) was higher, whereas the probability of having an indwelling urinary catheter was lower (odds ratio 0.70; 95% CI 0.53-0.91). Among residents living in psychogeriatric wards that employed BRNs, the probability of experiencing a medication incident was lower (odds ratio 0.68; 95% CI 0.49-0.95). For residents from both ward types, the probability of suffering from nosocomial pressure ulcers did not significantly differ for residents in wards employing BRNs.ConclusionsIn wards that employed BRNs, their mean amount of time spent per resident was low, while quality of care on most wards was acceptable. No consistent evidence was found for a relationship between the presence of BRNs in wards and quality of care outcomes, controlling for background characteristics. Future studies should consider the mediating and moderating role of staffing-related work processes and ward environment characteristics on quality of care.

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Section: Discussionmentioning

confidence: 99%

Relationship between the presence of baccalaureate-educated RNs and quality of care: a cross-sectional study in Dutch long-term care facilities

Backhaus

Rossum

Verbeek

et al. 2017

BMC Health Serv Res

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“…(16-18) These components of provider-to-provider relationships were shown to predict perceived work effectiveness in hospitals,(19) community based long-term care,(20) and in NHs. (21) The utility of using perceived work effectiveness as a predictor of care quality was demonstrated in hospitals(22) and in community-based LTC settings,(23-24) but not in NHs. We hypothesized that:

Hypothesis 1: NHs with higher perceived work effectiveness have fewer deficiency citations, ceteris paribus.

…”

Section: Prior Research and Proposed Hypothesesmentioning

confidence: 99%

Nursing Home Environment and Organizational Performance

Temkin‐Greener¹,

Zheng²,

Cai³

et al. 2010

Medical Care

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BACKGROUND Work environment attributes - job design, teamwork, work effectiveness - are thought to influence nursing home (NH) quality of care. However, few studies tested these relationships empirically. OBJECTIVE We investigated the relationship between these work environment attributes and quality of care measured by facility-level regulatory deficiencies. METHODS Data on work environment were derived from survey responses obtained (in 2006-2007) from 7,418 direct care workers in 162 NHs in NYS. Data on facility deficiencies and characteristics came from the OSCAR database. We fit multivariate linear and logistic regressions, with random effects and probability weights, to models with the following dependent variables: presence/absence of quality of life (QL) deficiencies; number of quality of care (QC) deficiencies; and presence/absence of high severity G-L deficiencies (causing actual harm/immediate jeopardy). Key independent variables included: work effectiveness (a 5-point Likert scale score); percent staff in daily care teams and with primary assignment. The work effectiveness measure has been demonstrated to be psychometrically reliable and valid. Other variables included staffing, size, facility case-mix, and ownership. RESULTS In support of the proposed hypotheses, we found work effectiveness to be a statistically significant predictor of all three measures of deficiencies. Primary assignment of staff to residents was significantly associated with fewer QC and high severity deficiencies. Greater penetration of self-managed teams was associated with fewer QC deficiencies. DISCUSSION Work environment attributes impact quality of care in NHs. These findings provide important insights for NH administrators and regulators in their efforts to improve quality of care for residents.

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“…Work related stress and burden results in high turnover [3-5], low morale and increased sick leave [6], seriously acting against quality care and resulting in staff shortage. Caring for care teams seems an important issue in the face of intensive need of institutional care in the future [7,8]. More generally, caregiver burden is defined as “Alterations in caregivers’ emotional and physical health, which can occur when care demands outweigh available resources” [9].…”

Section: Introductionmentioning

confidence: 99%

Professional Care Team Burden (PCTB) scale – reliability, validity and factor analysis

Auer

Graessel

Viereckl

et al. 2015

Health Qual Life Outcomes

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BackgroundThere is growing concern about how to provide care for persons with dementia in institutions such as nursing homes, day care centers, mobile services and hospitals. Care teams (formal caregivers) have to meet specific expectations from different sides: the Person with Dementia herself, the institution, and from different family members. Out of this situation, considerable burden can emerge hindering the professional development of care team members and counteracting quality of care of care recipients. So far there are very few specific reliable and valid scales measuring burden in care team members. Based on the theoretical concept of subjectively perceived burden, organizationally based factors of burden and structural factors of burden, we report on the construction of a care team burden scale and its scale quality criteria.MethodsBased on the theoretical three assumed sources of burden, a structured interview guide was developed. Interviews were held with professional caregivers. Through qualitative data analysis, an item pool consisting of 40 Items was constructed. Experts selected 19 items found most appropriate to measure the three theoretically based domains of burden. The Perceived Stress Scale (PSS) was chosen as a criterion in order to test discriminant validity. An exploratory factor analysis was performed.ResultsThe stepwise scale analysis revealed a 10 item solution. The Cronbach’s alpha was 0.785. The Pearson correlation between the PCTB 10 Item scale (mean score 10.2, SD = 5.0) and the PSS (mean score 13.0, SD = 5.9) was 0.46 (p < 0.001). All included items could clearly be assigned to one of three factors.ConclusionThe 10 item PCTB scale provides a valid and reliable means of obtaining ratings of burden from formal care teams working in nursing homes in order to evaluate different interventions targeted at the reduction of burden in care teams.Electronic supplementary materialThe online version of this article (doi:10.1186/s12955-014-0199-8) contains supplementary material, which is available to authorized users.

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Measuring Work Environment and Performance in Nursing Homes

Cited by 51 publications

References 33 publications

Relationship between the presence of baccalaureate-educated RNs and quality of care: a cross-sectional study in Dutch long-term care facilities

Relationship between the presence of baccalaureate-educated RNs and quality of care: a cross-sectional study in Dutch long-term care facilities

Nursing Home Environment and Organizational Performance

Professional Care Team Burden (PCTB) scale – reliability, validity and factor analysis

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