Medication Assistant-Certification Program in Washington State: Barriers to implementation.

Medication assistants (MAs) are a legal alternative that enables licensed nurses to safely delegate medication administration to stable residents in non-acute settings. The purpose of this study was to query the beliefs and understanding of skilled nursing facility staff regarding the Washington State Medication Assistant Endorsement Program (MAEP). A 15-item survey was developed and administered to a convenience sample of 218 nursing staff from five eastern Washington nursing homes. Most believed that MAs would not change the cost of care, nor would they enhance or reduce the quality of care provided to residents in skilled nursing facilities. The relatively few Licensed Practical Nurses surveyed (n = 19) were the least in favor of MAs, possibly fearing job loss with the addition of MAs to the staffing mix at their facilities. These factors in combination may reflect why MAEP has not yet been embraced by providers in Washington State.

The Influence of Cognitive Status on Elder Food Choice and Meal Service Satisfaction.

BACKGROUND: This article describes the testing of a new nursing home food delivery system that empowers elders to choose the foods they want to eat and gives them an active voice in menu development. METHODS: Using a 2-group, repeated measures design, 61 elderly residents from 2 eastern Washington nursing homes were recruited to participate in a 6-month study. Outcome measures included food and meal service satisfaction, body weight, serum prealbumin, and food intake. RESULTS: Serum prealbumin levels and body weight increased post intervention for treatment group residents. Mini-Mental Status Examination (MMSE) scores were not associated with the changes in serum prealbumin, body weight, or food intake. DISCUSSION: The MMSE scores did not influence the resident's ability to actively participate in the rate the food process or choose the foods they liked and preferred to eat. Cognitive impaired older adults experienced weight gain similarly to higher functioning elderly individuals.

Improving client and nurse satisfaction through the utilization of bedside report.

Bedside reporting improves client safety and trust and facilitates nursing teamwork and accountability; however, many nurses do not consider it best practice when caring for their clients. A literature review was conducted to determine whether bedside report is an essential shift handover process that promotes both client and nursing satisfaction. Implications for nurses in professional development are discussed, and strategies for developing and implementing bedside report using Lewin's theory of planned change are provided.

Quality improvement in nursing homes: testing of an alarm elimination program.

Falls are the most common cause of injury deaths and nonfatal injuries in older adults. In an effort to detect a resident's movement, many nursing homes use bed or chair alarms to alert staff that the resident may get up and possibly fall. However, there is little evidence that bed or chair alarms prevent falls, and mounting evidence that alarms can impede the functional status and negatively impact feelings of dignity among older adults in nursing homes. The purpose of this article was to describe the development and pilot testing of an alarm elimination program for nursing homes. A program aimed at decreasing or eliminating the use of alarms may enhance quality of life of older adults in nursing homes.

Minimizing nurses' risks for needlestick injuries in the hospital setting.

Despite advances in safety mechanisms for sharps, nurses continue to be at high risk for needlestick injuries, with more than half of all nurses experiencing at least one needlestick injury during their careers. Needlestick injury risk appears to be the result of three incident factors: nurses' sense of urgency, variable shift work, and lower skill level related to years of experience, academic degree, and younger age. This article synthesizes the evidence related to these risk factors among nurses in the hospital setting. Evidence linking needlestick injury risk with both variable shift work and lower skill level is demonstrated. The evidence supporting a relationship between needlestick injury risk and nurses' sense of urgency is conflicting. It is the authors' goal to reduce needlestick injury risk for nurses; therefore, specific changes to hospital nursing practice are recommended based on the evidence identified.

Food choice can improve nursing home resident meal service satisfaction and nutritional status.

The purpose of this study was to test the feasibility of implementing the Eat Right food delivery system and measure its impact on residents' food satisfaction, food intake, and subsequent nutritional status, including serum prealbumin levels and changes in body weight. Two eastern Washington State nursing homes (NHs) were recruited based on a similar case mix, the number of beds, and management's willingness to participate in the study. A total of 61 residents (NH A = 33, NH B = 28) participated. Intervention group residents (NH A) reported significant overall improvement in food service satisfaction and significant improvement in serum prealbumin levels after the intervention (p = 0.001). Changes in intervention group body weight improved after the intervention (p = 0.029). Use of nutritional interventions such as the multidimensional Eat Right system encourages resident decision making and facilitates overall satisfaction with care and improved health.

Leveling the playing field for nursing students with disabilities: implications of the amendments to the Americans with Disabilities Act.

Faculty have reported a significant increase in the number of nursing students with disabilities; however, misinformation regarding legislated changes in the definition of a disability, as enacted in 2008 under the American with Disabilities Act Amendments Act, has contributed to faculty confusion when working with students with disabilities. This article identifies the circumstances under which nursing faculty are legally required to provide reasonable accommodations for students with disabilities, as defined under the Americans with Disabilities Act of 1990 as amended in 2008, and the strategies faculty may use to assist students to successfully complete core requirements. When this knowledge is integrated into a nursing program's culture and curriculum, students with sensory loss, paralysis, mental illness, learning disabilities, limb differences, chronic illnesses, or other disabilities associated with impaired bodily functions can successfully complete nursing programs and provide excellent care to clients, the profession, and their communities.

Comparing needed training with topics of interest among assisted-living providers.

The purpose of this article is to describe a quality improvement program developed for assisted-living facilities in Washington State and to compare needed training with topics of interest of care providers in these assisted-living facilities. No national educational and training minimum requirements exist for unlicensed personnel charged with caring for older adults in assisted-living facilities. Minimum requirements specified in individual states vary from no training to that required of nursing assistants in skilled nursing facilities. Staff training is needed to ensure quality of care, quality of life, and resident safety.