Psychiatric disturbances of aged patients in skilled nursing homes

The authors found that 85% of 74 patients supported by Medicaid in two skilled nursing facilities had significant psychiatric disorders in addition to serious multiple medical illnesses. Almost two-thirds of the psychiatric disturbances had not been diagnosed. Although staff were more concerned with the psychosocial than the physical aspects of patients' problems in more than half of the cases, they often had difficulty recognizing the legitimacy of psychological complaints and relating to patients with psychological disturbances. Staff were not clear about the orders for psychotropic medications that were prescribed for more than half of the patients. The authors point out that more psychiatric consultation is needed to ensure appropriate and effective care for psychiatric patients in such facilities.     

Nurses helping nurses. Development of internal specialists in long-term care

The prevalence of psychiatric disorders and behavioral disturbances among nursing home residents, combined with observed deficits in geriatric mental health/illness expertise among LTC staff, supports the need for creative approaches to improve the knowledge, understanding, and management of such problems among LTC providers. The train-the-trainer model described in this article proved to be a viable method to providing geriatric mental health consultation and training that targets both improved quality of life for residents and quality of work life for the staff in charge of residents' care. More collaborative efforts among nursing specialists, subspecialists, and generalists are needed to empower those who work in LTC to utilize strengths and abilities inherent to their positions. Nursing homes nurses, who are all too familiar with the problems and challenges of their patient population, may act not only as mental health trainers but also as resource persons, role models, liaisons with geropsychiatric specialists, and leaders in the application of geropsychiatric care principles to residents within their facility, thus promoting improved resident and staff care alike.     

Improving certified nurse aide retention. A long-term care management challenge

In the long-term care industry, the turnover rate among nurse aides is extremely high. This adversely affects resident satisfaction, resident care, morale, and finances. It presents a challenge to long-term care administration. Refusing to accept high turnover as an impossible situation allows changes to be made. The authors describe how the staff at one intermediate care facility identified its problems, assessed the causes, and implemented corrective action.     

Swallowing problems in the nursing home: a novel training response

Various studies suggest that between 50% and 75% of nursing home residents have some difficulty in swallowing. Some of these residents are assessed and treated by speech pathologists, but many are managed by nursing staff without specialist input. A training program called Swallowing ... on a Plate (SOAP) has been developed by the Centre for Education and Research on Ageing and the Inner West Geriatrics and Rehabilitation Service to help address swallowing-related problems in local nursing homes (Inner West of Sydney, Australia). The training program teaches nursing staff how to identify, assess, and manage swallowing problems, including making appropriate referrals. Several new instruments were developed specifically for this program including two assessment checklists, a set of management guidelines, and a swallowing care plan. Evaluation of the program--including 3 months follow-up--showed it to be highly successful. A stand-alone training resource has been produced for wide distribution to help staff implement the program as a permanent aspect of their nursing care. This paper describes the development, content, presentation, resource, and evaluation of the above program.     

The correspondence of patient satisfaction and nurse burnout

This study examined the relationships of nurse burnout, intention to quit, and meaningfulness of work as assessed on a staff survey with patient satisfaction with nursing care, physician care, information provided and coordination of care, and outcomes of the hospital stay assessed post-discharge. Sixteen inpatient units from two hospital sites formed the data base and included 605 patients and 711 nurses. Patients' perceptions of the quality of each of the four care dimensions corresponded to the relationships nurses had with their work. Patients on units where nurses found their work meaningful were more satisfied with all aspects of their hospital stay. Patients who stayed on units where nursing staff felt more exhausted or more frequently expressed the intention to quit were less satisfied with the various components of their care. Although nurse cynicism was reflected in lower patient satisfaction with interactions with nursing staff, the correlations between cynicism and other aspects of care fell below statistical significance. No significant correlations were found between nurse professional efficacy and any of the patient satisfaction components measured. The implications of the relationship between patient satisfaction and nurses' perception of their work is discussed.     

Using the handicap code of the ICIDH for classifying patients by intensity of nursing care requirements

An 11-class patient classification system (PCS) has been built on a recode of two dimensions of the handicap code of the ICIDH: physical independence and mobility handicaps. The proposed system, called MAC XI, explains 78% of the variance of nursing care hours required by nursing-home residents and extended-care hospital patients. This percentage of variation is higher than the one explained by traditional dependency grids such as the Exton-Smith, Murphy, Kuntzmann and SMAF. MAC XI, based on two dimensions of the handicap code, is thus a powerful tool for predicting intensity of nursing care for staffing and budgeting purposes in long-term care institutions.     

Psychological services provided within Veterans Administration nursing homes.

[Correction Notice: An erratum for this article was reported in Vol 17(5) of Professional Psychology: Research and Practice (see record 2008-10955-001). In this article, the copyright information was incorrect. The correct copyright information is included in the erratum.] Surveyed the nature and scope of psychological services provided within 67 Veterans Administration nursing facilities to examine the emerging professional domain of the nursing home psychologist. Data regarding service delivery models, use of time, assessment and treatment services, multidisciplinary team activities, staff and student training, and research are provided. The profile of the ideal nursing-home psychologist that emerges from this survey is that of a well-rounded psychologist capable of rendering a full range of assessment, treatment, and consultative services while also functioning as a treatment team member, a teacher, a program developer, and a researcher. (40 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Consultation and the analysis of school faculty meetings.

Faculty meetings are frequently attended by school consultants and are frequently used for diagnostic, training, and evaluation purposes. To formalize what many psychologists may be doing presently, this article considers the means for analyzing faculty meetings to further (a) consultation activity, (b) consultation training, and (c) consultation evaluation. The social psychological approach described could be applied to staff meetings at institutions other than schools. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Breast awareness project for women with a learning disability

In 1995/6, while conducting a quality assurance evaluation in a residential group home for adults with a learning disability, the subject of breast screening and the importance of early detection of breast abnormalities was raised by a member of staff. At the time, the Mulberry Trust had a quality standard that women between 50 and 64 years who are supported in continuing care should attend breast screening clinics on a 3-yearly basis if they wish. A pilot scheme was devised based on the premise that breast awareness for service users should be promoted. It was decided that the scheme should include a breast examination, conducted on a monthly basis, ideally by the service users themselves, or by suitably trained staff on their behalf. The pilot scheme was implemented using available research and training was provided for qualified nursing staff within the trust. The training covered breast cancer prevention and breast awareness. After 7 months the scheme was evaluated and changes were made to policy and practice, including consultation with the trust's ethics panel regarding implementation of procedures. Training for staff in breast awareness continues and the scheme is slowly being introduced across the trust to enable all service users to be involved, both in residential homes and community settings. However, in future, the emphasis will be on identifying changes in the breast during normal care routines, such as bathing and dressing, as opposed to formal, clinical examination.     

Improving quality of sexually transmitted disease case management in rural South Africa

OBJECTIVE: To measure quality of sexually transmitted disease (STD) syndromic case management and aspects of health-seeking behaviour at baseline in an intervention trial. SETTING: Ten rural primary care clinics, Hlabisa district, South Africa. DESIGN: Simulated patients (fieldworkers trained to present with STD syndromes) made a total of 44 clinic visits; 49 STD patients were interviewed when exiting clinics; facilities were assessed for availability of necessary equipment and drugs; 10 focus group discussions were held with staff; and STD syndrome surveillance was performed in all 10 clinics. RESULTS: A total of 9% of simulated patients were correctly managed (given correct drugs, plus condoms and partner notification cards), recommended drug treatment was given in only 41% of visits, and appropriate counselling was given in 48% of visits. Among patients leaving the clinic, although 39% waited over an hour to be seen and only 37% were consulted in private, all reported staff attitudes as satisfactory or good. Only six clinics had syndromic management protocols available, three reported intermittent drug shortages, and seven lacked partner notification cards. Focus group discussions revealed good staff knowledge about STD, but showed lack of training in syndromic management and low morale. Surveillance data showed that while 75% of those presenting for care did so within 1 week of symptom onset, 27% had been treated for an STD in the preceding 3 months, and only 6% of those treated were contacts. CONCLUSIONS: Quality of STD case management was poor despite good staff knowledge and availability of most essential resources. An intervention comprising staff training and STD syndrome packets has been designed to improve quality of case management.     

The Medical Polyclinic: an approach to conflicting needs in a teaching hospital

University teaching hospitals have become increasingly aware of their responsibility to improve both the teaching of ambulatory care and the quality of care provided in their clinics. This paper describes how one department of medicine met this challenge by forming a "Medical Polyclinic." The majority of the department's faculty and house staff, at all academic and training levels, participate in a system of ambulatory care with the following objectives: each patient has a single physician whom he sees by appointment and who coordinates his care; all medical subspecialties are available in the same clinic session; the clinic is attractive and efficient. While these goals are not infrequently met in private group practices, they are unusual in a university teaching hospital, where faculty, house staff, students, and patients each have unique needs, not always compatible. The success and problems of the polyclinic approach are discussed.     

The professionalization of English prison psychologists.

Currently, about 90 psychologists are employed in the English prison service. Their major tasks are to (a) advise the prison governor and senior managerial staff on such topics as staff morale, inmate management, and communication; (b) train the staff; (c) diagnose, assess, and interpret psychological test information to match treatment to the inmate in allocation decisions; (d) provide treatment (e.g., individual and group counseling and psychotherapy, social skills training, and behavior modification); and (e) conduct research, especially on the effectiveness of treatments, the prediction of behavior after release, and validity of psychological tests and other assessment techniques. Major professional problems facing prison psychologists are (a) ethical issues (e.g., confidentiality, informed consent, and whether their clients are the prison staff or the prisoners; (b) restrictions on communication with professional colleagues; (c) lack of a recognized training course; (d) their status as specialist advisers rather than as part of the management structure; and (e) their lack of influence on governmental committees dealing with penal policy. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Primary Care Psychology Training on Campus: Collaboration Within a Student Health Center.

Applied psychological services are being implemented into the primary care treatment milieu to improve patient treatment and reduce health care costs. Unfortunately, few psychologists have training specifically oriented to working in this setting. A predoctoral training program wherein psychology graduate students may obtain practicum experience working in a student health center on a university campus is described. The theoretical underpinnings of this training are based on the integrated primary care models of K. Strosahl (1997) and K. Strosahl, N. Baker, M. Braddick, M. Stuart, and M. Handley (1997), which emphasize integration of psychological and medical treatment, brief intervention, consultation, and expedited referral for longer term cases. Though many issues remain, integrated primary care offers promise for improved health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Psychological services provided within Veterans Administration nursing homes": Correction to Kupke.

Reports an error in "Psychological services provided within Veterans Administration nursing homes" by Thomas Kupke (Professional Psychology: Research and Practice, 1986[Jun], Vol 17[3], 185-190). In this article, the copyright information was incorrect. The correct copyright information is included in the erratum. (The following abstract of the original article appeared in record 1986-28163-001.) Surveyed the nature and scope of psychological services provided within 67 Veterans Administration nursing facilities to examine the emerging professional domain of the nursing home psychologist. Data regarding service delivery models, use of time, assessment and treatment services, multidisciplinary team activities, staff and student training, and research are provided. The profile of the ideal nursing-home psychologist that emerges from this survey is that of a well-rounded psychologist capable of rendering a full range of assessment, treatment, and consultative services while also functioning as a treatment team member, a teacher, a program developer, and a researcher. (40 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How about a lollipop? A peer recognition program

A staff recognition program produces a chain reaction. Receiving the award increases self-esteem and social gratification. Giving the award fosters autonomy and leadership qualities. Through staff participation and recognition, morale and job satisfaction increase, which in turn raises the quality of patient care.     

Strategic planning. Implementing a foundation

An interdisciplinary continuum-of-care process achieves a unit's mission and enhances team excellence. Quality of patient care improves, costs decrease, staff satisfaction and morale increase, and a sense of team integration emerges. Strategic planning is an effective tool to actualize this process.     

Predicting patient satisfaction: a study of two emergency departments

To identify perceptions that predict overall patient (dis)satisfaction with Emergency Department (ED) care, we studied responses to a survey mailed to all discharged patients over a 6-month period (Academic Hospital), and to a telephone interview of a random sample of discharged patients over a 1-year period (Community Hospital). The survey and interview both assessed overall satisfaction, as well as satisfaction with perceived waiting times, information delivery, and expressive quality of physicians, nurses, and staff. Data for 1176 patients (training sample) and 1101 patients (holdout sample) who rated overall satisfaction as either "very good" or "very poor" (Academic Hospital), and for 856 patients (training sample) and 431 patients (holdout sample) who rated overall satisfaction as either "excellent" or "poor" (Community Hospital), were retained for analysis. For both hospitals, nonlinear tree models efficiently achieved overall classification accuracy exceeding 98% in training analysis and 95% in holdout analysis (all p < .0001). The findings suggest that overall patient (dis)satisfaction with care received in the ED is nearly perfectly predictable on the basis of patient-rated expressive qualities of ED staff, particularly physicians and nurses. Interventions designed to reinforce positive (and extinguish negative) expressive health-care provider behaviors may cut the number of extremely dissatisfied patients in half.