ABSTRACT
This article provides an overview of family involvement in care intervention and its implementation with African American and Caucasian family members of persons with dementia in nursing home settings.
Subject(s)
Black or African American/psychology , Caregivers/psychology , Cooperative Behavior , Dementia/nursing , Family/psychology , Nursing Homes , Nursing Staff/psychology , Professional-Family Relations , White People/psychology , Aged , Caregivers/education , Humans , Iowa , Missouri , Nursing Evaluation Research , WisconsinABSTRACT
The number of Special Care Units (SCUs) for people with Alzheimer's disease (AD) in nursing homes have increased dramatically in the past 10 years. Despite the rapid increase in number of SCUs and the concern that most SCUs report higher costs than traditional nursing home units where residents with AD are integrated with cognitively intact residents, the evaluation of costs has been largely unsystematic and noncomparative. Studies are urgently needed to assess comparative costs so that administrators and policy makers can make informed decisions. This article reviews studies that examine the costs of care in SCUs and presents cost-related data comparing the outcomes of care for residents with AD on a SCU and on traditional units in one long-term care setting.
Subject(s)
Alzheimer Disease/nursing , Health Care Costs , Hospital Units/economics , Long-Term Care/economics , Aged , Alzheimer Disease/economics , Cost-Benefit Analysis , Female , Health Services Accessibility , Health Services Research , Humans , Male , Outcome Assessment, Health Care , Personnel Staffing and Scheduling/economics , Social Class , WorkforceABSTRACT
Evaluation of a skin care protocol for the treatment of pressure ulcers in this institution showed that practitioners did adopt research-based practice. This change in practice was associated with a corresponding decrease in costs for treatment. More pressure ulcers received treatment after implementation of the protocol. Furthermore, the majority of pressure ulcers were being treated with wound care modalities identified by research as supportive of healing. Use of antiseptic agents harmful to the healing process declined as did use of topical agents with little research base to support their efficacy. The shift to practice patterns that were more consistent with research findings was associated with a corresponding decrease in costs for pressure ulcer treatment. Factors in this situation that lead to the positive outcome of knowledge utilization were an organizational model that promoted accountability of individual practitioners, staff participation in decision making, agency regard for research, and consultation with a nurse expert. Informal individual utilization of knowledge related to the treatment of pressure ulcers reinforced use of the research-based practice and expedited formal implementation of a policy/procedure related to their treatment. The process of knowledge utilization that occurred in this institution provides a prototype of how research can be translated into practice. Although limited to one specific clinical problem, the results of this process can be applied to any clinical condition where there are sufficient research findings to support development of recommendations for practice.
Subject(s)
Clinical Nursing Research , Pressure Ulcer/nursing , Pressure Ulcer/therapy , Aged , Clinical Trials as Topic , Diffusion of Innovation , Hospitals, Veterans , Humans , Hygiene , Middle Aged , Nursing Assessment , Skin , Transcutaneous Electric Nerve StimulationABSTRACT
Much of what is in the literature regarding nursing of AD patients and their families is anecdotal, has not been validated by systematic research, and is atheoretical. The majority of nursing research in AD has focused on patient characteristics and problem behaviors or on the needs and experiences of family care givers rather than on characteristics of SCUs. Research should continue in these areas, along with testing nursing interventions to maintain the optimal cognitive, physical, social, and emotional function of residents with AD in institutional settings. Explanatory theories should be devised and tested to advance the development of nursing knowledge in the care of residents with AD and family care givers. Finally, more evaluation research is needed to test the cost effectiveness of SCU programs, including effects on residents with AD, family members, and staff care givers.
