Attracting nurses to long-term care

1. A major issue facing nursing, and society as a whole, is the longstanding and continuing nursing shortage in long-term care. 2. The demand for RNs in nursing homes will continue to intensify into the next century as the population of older adults with complex care needs continues to grow. 3. The findings of this study suggest that RN recruitment needs in long-term care include having enough qualified and dedicated staff, supportive and competent administration; competitive salaries and benefits; functional, attractive facilities; improved professional and public image; a caring, supportive environment; realistic regulations; decreased paperwork; progressive nurse practice models; and opportunities for educational advancement and career growth.     

Death in the operating room and postanesthesia care unit: helping nurses to cope

The present paper offers data to suggest an effect of geographic latitude in regard to the frequency of conception in human populations. The birth statistics from eight countries in different parts of the world have been evaluated. A particularly strong minimum appears to occur in almost all regions but is shifted in time with changing latitude.     

Geropsychology in long-term care settings.

Discusses services trained psychologists can offer in long-term care settings for the aged, including individual assessment, psychotherapy, staff training, program consultation, and development. (50 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health care policy and long-term care.

Discusses changes in the age structure of the nation, the locus of care, the nature of disease, and the cost of care as factors that have led to recent proposed revisions in health-care policy. The need for increased future involvement of a rehabilitation philosophy as a response to the current crisis in policy is examined. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of long-term care in an acute care institution and in a long-term care institution

BACKGROUND: Acute care hospitals in Quebec are required to reserve 10% of their beds for patients receiving long-term care while awaiting transfer to a long-term care facility. It is widely believed that this is inefficient because it is more costly to provide long-term care in an acute care hospital than in one dedicated to long-term care. The purpose of this study was to compare the quality and cost of long-term care in an acute care hospital and in a long-term care facility. METHODS: A concurrent cross-sectional study was conducted of 101 patients at the acute care hospital and 102 patients at the long-term care hospital. The 2 groups were closely matched in terms of age, sex, nursing care requirements and major diagnoses. Several indicators were used to assess the quality of care: the number of medical specialist consultations, drugs, biochemical tests and radiographic examinations; the number of adverse events (reportable incidents, nosocomial infections and pressure ulcers); and anthropometric and biochemical indicators of nutritional status. Costs were determined for nursing personnel, drugs and biochemical tests. A longitudinal study was conducted of 45 patients who had been receiving long-term care at the acute care hospital for at least 5 months and were then transferred to the long-term care facility where they remained for at least 6 months. For each patient, the number of adverse events, the number of medical specialist consultations and the changes in activities of daily living status were assessed at the 2 institutions. RESULTS: In the concurrent study, no differences in the number of adverse events were observed; however, patients at the acute care hospital received more drugs (5.9 v. 4.7 for each patient, p < 0.01) and underwent more tests (299 v. 79 laboratory units/year for each patient, p < 0.001) and radiographic examinations (64 v. 46 per 1000 patient-weeks, p < 0.05). At both institutions, 36% of the patients showed anthropometric and biochemical evidence of protein-calorie undernutrition; 28% at the acute care hospital and 27% at the long-term care hospital had low serum iron and low transferrin saturation, compatible with iron deficiency. The longitudinal study showed that there were more consultations (61 v. 37 per 1000 patient-weeks, p < 0.02) and fewer pressure ulcers (18 v. 34 per 1000 patient-weeks, p < 0.05) at the acute care hospital than at the long-term care facility; other measures did not differ. The cost per patient-year was $7580 higher at the acute care hospital, attributable to the higher cost of drugs ($42), the greater use of laboratory tests ($189) and, primarily, the higher cost of nursing ($7349). For patients requiring 3.00 nursing hours/day, the acute care hospital provided more hours than the long-term care facility (3.59 v. 3.03 hours), with a higher percentage of hours from professional nurses rather than auxiliary nurses or nursing aides (62% v. 28%). The nurse staffing pattern at the acute care hospital was characteristic of university-affiliated acute care hospitals. INTERPRETATION: The long-term care provided in the acute care hospital involved a more interventionist medical approach and greater use of professional nurses (at a significantly higher cost) but without any overall difference in the quality of care.     

Nurse practitioners, practice nurses and nurse specialists: what''s in a name?

Nitric oxide (NO) readily makes corresponding complexes not only with ferrous iron but also with ferric iron. However, NO-ferric complexes of many heme proteins were unstable, while horseradish peroxidase formed the very stable NO-ferric porphyrin complex with a shift of the Soret band of the absorption wavelength from 396.5 nm to 420.0 nm. The concentration of NO in aqueous media could be monitored by measuring the absorption changes, and the detection limit was 10 nM. The simple procedure is convenient for concentration determination of NO solution.     

Quality of care in intensive care units. Retrospective study on long-term patients]

Nursing care must be evaluated in order to determine its effectiveness and identify deficiencies, which makes it possible to introduce corrective measures to optimize quality. The quality of care given to patients in our unit was evaluated with a retrospective analysis of 915 records in the Nursing Care Plan corresponding to 59 patients with a mean ICU stay of 15.5 days. Six areas of care and indicators of deficient practice were identified: orotracheal intubation: accidental disconnection, displacement, obstruction, and pressure sores on lips; arterial catheterization: accidental disconnection and obstruction; central venous catheterization: accidental disconnection and contamination; urinary catheterization: accidental disconnection and urinary bacteriology; nasogastric intubation: accidental disconnection, obstruction, and nasal pressure sores; conservation of skin integrity: presence of pressure sores, and prevention of falls from the bed or chair. The reference standards were taken from the published literature. The results show that airway care was adequate, although the frequency of pressure sores on the lip produced by orotracheal tubes was high. The indicators for following up the care of vascular and urinary catheters showed results similar to established standards. There was a high rate of nasogastric tube obstruction due to the administration of medication. Finally, the frequency of pressure sores was well below established standards and there were no accidental falls. It is concluded that the detection of areas in which care is deficient requires an analysis of relevant nursing activities so that corrective measures can be taken. This study is a useful baseline for future quality control.     

Geropsychology practice: One psychologist's experience in long-term care.

The rapidly developing field of Clinical Geropsychology was acknowledged as a proficiency in 1998 by the American Psychological Association. This article presents one psychologist's perspective in an account of her 3 1/2 years of clinical experience working with an ethnically diverse, elderly cohort in a small, state-financed nursing home in Hawaii. Some practice setting challenges are presented, along with a portrayal of the benefits of interdisciplinary practice. The experiences described in this article are intended to provide support for the fundamental value and relevance of the Guidelines for Psychological Practice With Older Adults, and to encourage a more eclectic, adaptive, and inclusive practice model of therapy with the elderly that is evidence-based, person-centered, and systems-oriented. The author's experiences strongly suggest that these issues should be incorporated into the research and training methodology for Clinical Geropsychology in order to address the distinct needs of its elderly clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment and intervention by rehabilitation psychology in long-term care.

Argues that an effective program of rehabilitation psychology in long-term care depends on an understanding of the conceptual bases for such care—the dynamic relationship between support and autonomy and the strategy of incremental gains. Ideally, rehabilitation psychology involves 2 forms of assessment: one to establish generalized function and the other (a more traditional clinical assessment) to establish the basis for clinical intervention. The role of psychologists in management should range from standard interventional techniques with patients to a significant role in helping the institution and the residents themselves as a group in dealing with institutional care. The many barriers to the delivery of mental health services, particularly in reimbursement, may be overcome through creative enterprise. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Models of helping and coping.

Draws a distinction between attribution of responsibility for a problem and attribution of responsibility for a solution. Four general helping models are derived. In the "moral" model, actors are held responsible for both problems and solutions and are believed to need only proper motivation. In the compensatory model, people are responsible only for solutions and are believed to need power. Individuals in the medical model are responsible for neither problems nor solutions and are thought to need treatment. In the enlightenment model, actors are responsible for problems but are unable or unwilling to provide solutions; they need discipline. It is maintained that each set of assumptions has characteristic consequences for the competence, status, and well-being of actors and that the wrong choice of model in a situation will undermine effective helping and coping. Competing models of responsibility in education, psychotherapy, law, and welfare are described, and research on attribution of responsibility is recommended as a way of addressing problems of both theoretical and social significance. (128 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of modeling procedures in helping relationships.

Discussed the clinical utility of modeling techniques in terms of a growing trend in which psychotherapy is viewed as part of a broader psychology of behavior change. Modeling techniques can be important facilitators of change, but their application to clinically helpful relationships is impeded by a paucity of research investigating the operation of modeling procedures in clinical-like settings. Intermediate steps or "bridging" research is needed before experimentally derived hypotheses can be applied clinically. The C. Whalen (see 44:2) study, which is 1 such "bridge," describes the effort needed for modeling procedures to be effective in adult groups and illustrates the need for constant attention to setting and context factors if a systematic psychology of behavior change is to be developed. (20 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Foreword to the special issue on long-term care.

This special issue on long-term care, guest edited by Carl and Susan Eisdorfer, addresses an issue that is rapidly becoming the most important health policy issue of the 1980s. The dilemma that we face as citizens and as rehabilitation professionals alike centers on our rapidly growing population of elderly citizens. While we have made unprecedented medical advances that have allowed for greater longevity, our health and social policies have not kept pace with these advances. We are therefore ill-equipped to deal with the myriad of economic, social, and health issues that confront our nation's elderly citizens. This issue of Rehabilitation Psychology is an attempt to address these questions by individuals who are leaders in the field of aging and long-term care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)