Psychological and Structural Burdens and Nursing Home Administrator Turnover Intentions During the COVID-19 Pandemic.

The COVID-19 pandemic created challenges for U. S. nursing home administrators (NHA) and staff. This study explored organizational and psychological factors associated with NHA stress, dissatisfaction, and turnover intent (TI) during the third year of the pandemic. Results from a nationwide, cross-sectional survey of 1139 NHAs were merged with Centers for Medicare and Medicaid Services nursing home survey deficiency, staffing, complaint, and other operations data. A hierarchical, generalized estimating equations model with ordered logit link found that NHAs with higher COVID stress (AOR = 1.65, 95% CI = 1.22, 2.23), higher use of agency/contract staff (AOR = 1.50, 95% CI = 1.08.2.09) and higher role conflict were more likely to indicate TI. NHAs with higher job satisfaction in workload, work content, and rewards were less likely to hold TI. Industry leaders should create strategies to reduce NHA's job stress and role conflicts and provide opportunities for improving staff recruitment and retention, reducing reliance on agency staffing.

The importance of communication and involvement in decision-making: A study in Ireland exploring birth satisfaction using the Birth Satisfaction Scale-Revised (BSS-R).

INTRODUCTION: Evaluation in healthcare services has become a priority, globally1. The Government of Ireland has highlighted the importance of stakeholder engagement to identify the needs of women in the design and delivery of high-quality health services, driven by necessity rather than financial ability2. The Birth Satisfaction Scale-Revised (BSS-R), an internationally validated tool, and recommended for measuring childbirth satisfaction by the International Consortium for Health Outcomes Measurement (ICHOM)3; however, it has yet to be considered in the Irish context. The aim of the study was to explore birth satisfaction with a sample of new mothers in Ireland. METHODS: A mixed-methods study was conducted including a survey that involved collection of data from the BSS-R 10-item questionnaire from 307 mothers over an 8-week period in 2019, in one urban maternity hospital in Ireland. Quantitative and qualitative data were collected. Qualitative data from the free-text comments of the survey questions were analyzed using content analysis. RESULTS: Overall, women reported positive relationships with their care providers and were satisfied with the communication and support they received, as well as high levels of control and choice. Postnatal care, however, was highlighted as being less satisfactory with staffing levels described as inadequate. CONCLUSIONS: Understanding women's birth experiences and what is important to them could facilitate midwives and other health professionals to improve the quality of their care and develop guidelines and policies that focus on women and their families' needs. The vast majority of women rated their birthing experience as extremely positive. The main elements of care that contributed to a positive birthing experience for women were quality relationships with clinicians, choice and control, and emotional safety.

Virtual reality in midwifery education: A mixed methods study to assess learning and understanding.

BACKGROUND: Virtual reality learning environments (VRLEs) are a potentially valuable learning tool that have recently increased in popularity due to widespread availability and decreased cost. VRLEs can provide an immersive learning environment that increases the understanding of three-dimensional relationships between anatomical structures. However, there is a paucity of evidence in the literature supporting its use within Midwifery education. OBJECTIVES: To explore the effectiveness of a VRLE as an educational tool in midwifery education. SETTING: A large University in Ireland, with institutional ethical approval. PARTICIPANTS: Undergraduate and graduate degree midwifery students. DESIGN: A descriptive qualitative and quantitative study was carried out. Data collection was carried out between September 2020 and March 2021. METHODS: Participants underwent a VRLE lesson based on the topic of fetal lie, position, and presentation in pregnancy. A multiple-choice questionnaire was used to quantitatively evaluate knowledge before and immediately after the intervention, and knowledge retention after one week. Qualitative data was collected using open-ended questions in the questionnaire. The primary outcome was a difference in pre- and post-intervention knowledge scores. Data was analysed using repeated measures one-way ANOVA. Qualitative data was analysed using thematic analysis and simple content analysis. All students participated in the quantitative and qualitative components of the study. Secondary outcomes included participant satisfaction and self-confidence in learning which were analysed using thematic analysis. The side effect profile of the virtual reality device was also explored using open-ended questions in the questionnaire. RESULTS: Forty-one midwifery students participated in the study, with a 100 % participation and response rate. Repeated measures one-way ANOVA revealed no statistically significant differences in knowledge scores pre- and post-intervention. Participants rated high satisfaction and self-confidence scores with regard to the VRLE as a learning modality. Side effects most commonly experienced by participants included dizziness (49 %), disorientation (30 %) and symptoms similar to motion sickness (32 %). The following themes were identified: "Learning in 3D", "The Power of Visual Learning", "The value of Educational Technology", "Learning can be fun and enjoyable". CONCLUSIONS: This study showed that the VRLE had no impact on knowledge gain, though high levels of satisfaction and self-confidence indicate a positive response to the VRLE. VRLEs are a potentially valuable learning tool to help enhance the student learning experience, promoting increased engagement, satisfaction, and self-confidence with the learning material.

Team inclusion and empowerment among nursing staff in long-term care.

Team-based approaches to long-term care are increasingly part of the landscape in residential care facilities to improve staff performance and resident outcomes vis-à-vis empowering direct care staff. This study characterizes licensed and unlicensed nursing staffs' (N = 95) perceptions of inclusion as care team members by co-workers, supervisors and non-nursing clinicians. Further, we explored whether inclusion was correlated with heightened empowerment and its related dimensions using the Perception of Empowerment Instrument. Linear regression analyses revealed that levels of total empowerment, autonomy, responsibility and participation were associated with how included team members felt and by which members of the care team. These findings shed light on the potential importance of tailoring staff training to target specific team members to increase a sense of empowerment that aligns with the specific dimension(s) for a targeted group.

Bereavement care education and training in clinical practice: Supporting the development of confidence in student midwives.

AIMS: To improve the confidence in student Midwives to provide bereavement careto parents following pregnancy loss and perinatal death. BACKGROUND: The one-day interactive Educational Training Workshop in Bereavement Care (ETWBC) was developed for student midwives in their final year of their B.Sc. Midwifery Degree Programme and those completing a Higher Diploma in Midwifery to help improve their confidence to provide bereavement care in clinical practice. DESIGN: A longitudinal sequential mixed-methods design was used to evaluate the outcome and processes of participation in the Workshop. This paper reports on the outcome evaluation. METHODS: Participants completed the study questionnaires at all 3 time points: pre/post workshop and 3 month follow-up. Thirty nine of the 41 student midwives (Higher Diploma and 4th year B.Sc.) participated in the workshop. 97.44% (n = 38) of the participants completed all the questionnaires. RESULTS: Participation in the ETWBC increased student's midwives confidence (measured using knowledge and skills scales); Bereavement support skills [F(2,72) = 21.150, p < .000, partial eta squared = 0.370] and Bereavement support knowledge [F(1.6,60) = 48.460, p < .000, partial eta squared = 0.567]to provide bereavement care. Improvement in Student Midwives' level of self-awareness of the needs of bereaved parents [F(2,72 )= 20.311, p < .000, partial eta squared = 0.361] and of their own personal needs [F (1.7, 61) = 30.387, p < .000, partial eta squared = 0.458] in relation to providing bereavement support were also found. CONCLUSION: Participation in the Education Training Workshop on Bereavement Care helped increase student midwives confidence to provide bereavement care to grieving parents and to increase their self-awareness around their clinical practice in this area. The ETWBC is recommended as a brief effective educational intervention for inclusion in Midwifery curricula which could be modified for use with other relevant professional groups.

Health Care Merged With Senior Housing: Description and Evaluation of a Successful Program.

Objective: This article describes and evaluates a successful partnership between a large health care organization and housing for seniors. The program provides on-site, primary care visits by a physician and a nurse in addition to intensive social services to residents in an affordable senior housing apartment building located in Pennsylvania. Per Donabedian's "Structure-Process-Outcome" model, the program demonstrated positive health care outcomes for its participants via a prescribed structure. To provide guidance for replication in similar settings, we qualitatively evaluated the processes by which successful outcomes were obtained. Methods: With program structures in place and outcomes measured, this case study collected and analyzed qualitative information taken from key informant interviews on care processes involved in the program. Themes were extracted from semistructured interviews and used to describe the processes that helped and hindered the program. Results and Discussion: Common processes were identified across respondents; however, the nuanced processes that lead to successful outcomes suggest that defined structures and processes may not be sufficient to produce similar outcomes in other settings. Further research is needed to determine the program's replicability and policy implications.

Evaluating midwife-led antenatal care: choice, experience, effectiveness, and preparation for pregnancy.

OBJECTIVE: to evaluate midwife-led care (MLC) antenatal care compared with antenatal care provided in traditional obstetric-led hospital antenatal clinics (usual care). DESIGN: a mixed methods approach involving a chart audit, postal survey, focus group and in-depth interviews. SETTING: data were collected at a large maternity hospital and satellite clinics in Dublin from women attending for antenatal care between June 2011 and May 2012. PARTICIPANTS: 300 women with low-risk pregnancy who attended midwife-led antenatal care or usual clinics during the study period were randomly selected to participate. MEASUREMENTS: data were collected from 292 women׳s charts and from 186 survey participants (63% response rate). Nine women participated in in-depth interviews and a focus group. FINDINGS: MLC was as effective as usual care in relation to number of antenatal visits and ultrasound scans, referral to other clinicians, women׳s health in pregnancy, gestation at childbirth, and birth weight. Women attending MLC booked significantly earlier, fewer women attending MLC were admitted to hospital antenatally and more women breast fed their infant. Women attending MLC reported better choice and that shorter waiting times and having more time for discussion were important reasons for choosing MLC. Women attending MLC reported a better experience overall, and recorded better outcomes in relation to how they were treated, along with easier access to antenatal care and shorter waiting times to see a midwife. Although women attending MLC clinics reported higher satisfaction with the information that they received, they also identified that antenatal education could be improved in relation to labour, breast-feeding, depression and emotional well-being, and caring for the infant. KEY CONCLUSIONS: midwife-led antenatal care was as effective as usual care for women with low-risk pregnancy and better in relation to choice, breast feeding and women׳s experience of care.

North Carolina's direct care workforce development journey: the case of the North Carolina New Organizational Vision Award Partner Team.

BACKGROUND: Better Jobs Better Care was a five-state direct care workforce demonstration designed to change policy and management practices that influence recruitment and retention of direct care workers, problems that continue to challenge providers. PURPOSE: One of the projects, the North Carolina Partner Team, developed a unified approach in which skilled nursing, home care, and assisted living providers could be rewarded for meeting standards of workplace excellence. This case study documents the complex adaptive system agents and processes that coalesced to result in legislation recognizing the North Carolina New Organizational Vision Award. METHODS: We used a holistic, single-case study design. Qualitative data from project work plans and progress reports as well as notes from interviews with key stakeholders and observation of meetings were coded into a simple rubric consisting of characteristics of complex adaptive systems. FINDINGS: Key system agents in the state set the stage for the successful multistakeholder coalition. These included leadership by the North Carolina Department of Health and Human Services and a several year effort to develop a unifying vision for workforce development. Grant resources were used to facilitate both content and process work. Structure was allowed to emerge as needed. The coalition's own development is shown to have changed the context from which it was derived. PRACTICE IMPLICATIONS: An inclusive and iterative process produced detailed standards and measures for the voluntary recognition process. With effective facilitation, the interests of the multiple stakeholders coalesced into a policy response that encourages practice changes. Implications for managing change-oriented coalitions are discussed.

Measuring worker turnover in long-term care: lessons from the better jobs better care demonstration.

PURPOSE: Turnover among direct-care workers (DCWs) continues to be a challenge in long-term care. Both policy makers and provider organizations recognize this issue as a major concern and are designing efforts to reduce turnover among these workers. However, there is currently no standardized method of measuring turnover to define the scope of the problem or to assess the effectiveness of interventions. This article draws on our experience of the Better Jobs Better Care Demonstration (BJBC) to explicate some important issues in measuring and interpreting turnover related to interventions designed to improve DCW jobs. DESIGN AND METHODS: We used turnover data from a selected group of BJBC providers (N = 9) to demonstrate some of the measurement issues we uncovered in developing a turnover tracking system for BJBC. We also illustrate how the data elements collected in the tracking system make it possible to construct measures that are useful at both policy and practice levels. RESULTS: Differences in definitions of turnover and the data elements used to construct the measure can have large effects on turn over rates, how they are used, and what they mean. IMPLICATIONS: Policy makers, researchers, and managers who need comparative turnover information to address the impending demand for DCWs should be aware that turnover measures differ, and they should take steps to ensure that measures they use have common definitions and data elements.

Nurse aide empowerment strategies and staff stability: effects on nursing home resident outcomes.

PURPOSE: This study examines the moderating effect of staff stability on the relationship between management practices used to empower nurse aides and resident outcomes in a multistate sample of nursing homes. An adaptation of Kanter's theory of structural power in organizations guided the framework for the model used in this study. DESIGN AND METHODS: Management practices and nurse aide staff stability measures were taken from a survey of directors of nursing (n = 156) and day-shift charge nurses (n = 430) in a stratified random sample of nursing facilities in Maine, Mississippi, New York, and Ohio (n = 156). Facility risk-adjusted pressure ulcer incidence rates and social engagement scores, taken from the Minimum Data Set, served as resident outcome measures. A hierarchical linear regression model was used to test the moderating effect of staff stability. RESULTS: The situation in which higher numbers of rewards were given to nurse aide staff was associated with lower incidence of pressure ulcers, whereas the situation in which nurse aides had more influence in resident care decisions was associated with higher aggregate social engagement scores. The inclusion of nurse aide staff stability in the regression model provided additional explanatory information for the relationship between management practices and resident outcomes. Facilities experiencing low turnover and high retention were associated with lower pressure ulcer incidence, whereas facilities with high turnover and high retention were associated with higher social engagement scores. IMPLICATIONS: This study suggests that certain management practices used to empower nurse aides can influence resident outcomes. Further, effects of nurse aide staff stability vary with respect to the physical versus psychosocial nature of the outcome.

A structure-technology contingency analysis of caregiving in nursing facilities.

The purpose of this paper is to describe how the work associated with psychosocial and physical caregiving is structured within nursing facilities. Arguing from a contingency perspective, our central hypothesis is that because the technology underlying physical care is less variable and more interpretable and the process-outcome relationships underlying care processes are better understood than for psychosocial care, work in the physical care domain will be comparatively more mechanistically structured even though work in both domains is performed by the same paraprofessional nurse aide staff. Data for this analysis derive from a survey of unit charge nurses (n = 739) in 308 nursing homes in eight states undertaken as part of a large NIA-funded study of the relationship between nursing home organization and resident outcomes. With the exception of centralization, contingency theory correctly predicts how the work associated with physical and psychosocial care is differentiated.