Caregiving in nursing homes. Views of licensed nurses and nursing assistants.

This investigation is a qualitative study of the views held by 36 licensed nurses (25 registered nurses and 11 licensed practical nurses) and 40 nursing assistants regarding caregiving in nursing homes. Because these care providers are most directly involved in the delivery of care, their views are important as determinants of quality of care. Study findings focus on the extent to which nurses and nursing assistants agree on what contributes to good care and how they perceive the work that each does. Also reported are their perceptions regarding factors that make care delivery easy or difficult. Results suggest that nurses and nursing assistants share selected perceptions about the division of labor in the nursing home. Also evident are areas of less agreement among these members of different status sets. A discussion of how these caregivers can work together as effective team members is presented.

Understanding nursing home quality of care: incorporating caregivers' perceptions through structure, process, and outcome.

Nursing home quality of care has been influenced by the Omnibus Budget Reconciliation Act of 1987. This legislation mandated changes within the structure, process, and outcomes of care. These care elements are examined from the viewpoints of 32 licensed nurses and 40 nurse assistants. Accounts of good care, obtained through focus groups, are presented within the context of structure, process, and outcome to understand quality care. Implications about training nursing personnel are considered within the structure and the process of care and how these elements affect care outcomes.

Stayers and leavers: a comparison of nurse assistants employed in nursing homes.

Careful screening of the attitudes and values of nurse assistant applicants is an important aspect of selecting good care providers who will remain in their positions.

An investigation of the impact of social support on the outcome of an alcoholism treatment program.

This study examines the role of social support in recovery from the chronic illness of alcoholism. Symbolic interactionism provides the theoretical framework from which two hypotheses are derived--one of which deals with the amount of social support available to patients during treatment and one of which deals with the social support actually experienced during treatment. Self-administered questionnaires were given to 83 patients enrolled in an inpatient treatment program in a midwestern city in the United States. Although patients did show a significant improvement in self-concept during the course of the treatment, neither of the hypotheses was supported by the data. Conceptual and measurement problems associated with the utilization of social support as a variable are discussed.

Experiences with home hospice care: determinants of place of death.

During the past few years the United States has witnessed the growth of hospice care as an alternative approach for the care of the terminally ill. This paper examines a sample of patients who elected to enroll in a home hospice program. Approximately 57 percent of these patients remained at home until death. The other 43 percent chose to return to a facility where they eventually died. Evidence indicates that patients and caregivers who have more difficulty with terminal care at home are more likely to return to a facility. The analysis explores factors that explain why some patients and caregivers have a more troublesome experience with terminal care at home. Four of the factors tested are found to be related to place of death: (1) the number of visits from hospice nurses, (2) the intensity of contact with the hospice nurses, (3) length of time patients are enrolled in the hospice program, and (4) race of the patient. The implications of these findings are discussed and recommendations for delivery of hospice services are suggested.

The needs of hospice patients and primary caregivers.

It would appear that hospice care providers in the program investigated here are highly accurate in their perceptions of their clients' needs. The program therefore is in an excellent position to accomplish its goals. However, findings also suggest that nurses are most accurate in their perceptions of social, emotional, and physical needs. They don't do as well in estimating the importance of material needs, such as financial and legal concerns. Nurses are also more likely to misperceive the importance of religious and spiritual needs. Hospice programs might consider implementing a structural mechanism to assist nurses in the task of understanding these patient and family concerns. Encouraging nurses to routinely inquire about the need for assistance with these issues is one potential remedy. Specific in-service training to teach nurses how to cue in on material and religious needs may also be beneficial. Another approach would be to further integrate staff persons who have specific training in understanding these types of needs into hospice programs. Attorneys, financial consultants, and clergy may need direct contact with patients and families rather than being called into a specific case only after nurses identify the need. Another implication of these results stems from the finding that nurses' perceptions become more similar to caregivers over time. This is particularly true for the assessment of patients' needs. Previous research shows that a substantial proportion of patients do not enter hospice until a few days prior to their deaths.(ABSTRACT TRUNCATED AT 250 WORDS)