Expert nursing assistant care activities.

Expert nursing assistants (NAs) described a broad range of care activities provided for nursing home residents. Data from in-depth interviews were analyzed using a naturalistic inquiry approach. Functional care activities addressed activities of daily living. Seven types of psychosocial care activities promoted emotional and mental health. NAs also described activities beyond the scope of their training, yet delegated by licensed nurses. Identification of expert NA contributions to resident care, proposed as the highest level of NA care possible, can guide development of educational programs and evaluation instruments. Awareness of delegated activities can direct research regarding their safety and legality.

Patient satisfaction with nurse practitioner care in primary care.

This quantitative, descriptive pilot study assessed patient satisfaction with care provided by four nurse practitioners using a modified version of the Di Tomasso-Willard Patient Satisfaction Questionnaire. Results indicated high satisfaction with care in all groups, but there were differences among the groups on 26 percent of the items and on three of the five subscales. The implication is that nurse practitioners need to identify and improve those dimensions of care for which patients are less satisfied.

Accuracy of nurse aides' functional health assessments of nursing home residents.

BACKGROUND: Nurse aides provide assessments of nursing home residents' functional health for use in care planning and quality assurance. Nurse practitioner assessments can serve as a standard for analysis of nurse aides' accuracy. This study compared nurse aide to nurse practitioner assessments of nursing home residents' functional health with regard to possible bias and extent of correlation. METHODS: Nurse aides' accuracy in assessing nursing home residents' activities of daily living was evaluated by comparisons to assessments performed by a master's-prepared nurse practitioner using four functional assessment instruments: the Barthel Index, the Katz Index of Activities of Daily Living, the Multidimensional Observation Scale for Elderly Subjects, and the Scaled Outcome Criteria. Data were collected in a 159-bed nonprofit nursing home licensed for skilled and intermediate care. Residents had a wide variety of functional and cognitive abilities and disabilities. Ninety-six nursing home residents provided data for the study. Functional health assessments by 24 nurse aides, each assessing 4 different nursing home residents, were compared to those of 1 nurse practitioner. Statistical analysis of accuracy used paired samples t-tests and Pearson product moment correlation coefficients. RESULTS: Nurse aide assessments and nurse practitioner assessments were highly correlated. Most functional health assessments evidenced no significant nurse aide bias. When bias was present it usually resulted from nurse aides electing more optimistic choices when using an assessment instrument that offered fewer response levels for rating residents. CONCLUSIONS: Nurse aides can accurately use well-calibrated instruments to assess nursing home residents' functional health. Demonstration of assessment accuracy in nurse aides, who provide the majority of direct care for nursing home residents, documented a valuable clinical resource for planning and evaluating resident care.