Academic practice partnerships: a national dialogue.

Academic-practice partnerships are an important mechanism to strengthen nursing practice and help nurses become well positioned to lead change and advance health. Through implementing such partnerships, both academic institutions and practice settings will formally address the recommendations of the Institute of Medicine Future of Nursing Committee. Effective partnerships will create systems for nurses to achieve educational and career advancement, prepare nurses of the future to practice and lead, provide mechanisms for lifelong learning, and provide a structure for nurse residency programs. This paper details the work of the American Association of Colleges of Nursing-American Organization of Nurse Executives Task Force on Academic-Practice Partnerships that has identified hallmarks of successful partnership and produced tools and shared exemplars to assist nursing leaders in developing and sustaining partnerships for the future.

Beyond CMS quality measure adjustments: identifying key resident and nursing home facility factors associated with quality measures.

OBJECTIVE: This quality improvement (QI) project was initiated to understand what differentiates nursing homes (NHs) that perform well on publicly reported Centers for Medicare and Medicaid Services (CMS) Quality Measures (QMs). The intent was to assist NH staff to direct QI efforts to positively impact QM rates. A key step was to determine if any resident or facility characteristics might account for some of the variability in QMs of high-risk pressure ulcers (HRPrUs), low-risk incontinence (LRI), and Activities of Daily Living (ADL) decline, beyond those already adjusted for by CMS. DESIGN: Observational Study. SETTING AND PARTICIPANTS: The setting was 147 NHs across 12 northeast states owned by 1 for-profit, multifacility organization in 2006 and 2007. INTERVENTION: None MEASUREMENTS: Minimum Data Set (MDS), patient admission information, facility staffing metrics, and CMS QM data. RESULTS: Relationships of facility and resident characteristics to QMs were evaluated using regression analyses performed separately for 2006 and 2007. Among factors found consistently to be significant (P < or = .05) for HRPrUs were percent admissions with pressure ulcers and percent residents with end-stage disease. For LRI, there was significant association with percent residents readmitted and percent incontinent of bladder on admission. ADL decline showed significant associations with licensed nurse turnover and facilities in specific states. CONCLUSION: Several resident and facility factors were associated with QMs beyond those previously adjusted for by CMS. With introduction of MDS 3.0, we suggest further exploration of resident and facility factors identified in this study.

Continence care for obese nursing home residents.

Obesity is a significant and increasing health problem for older individuals, caregivers, and health care financing and delivery systems. While the relationship between obesity and urinary incontinence has been studied fairly extensively in community-dwelling individuals, little is known about obesity and continence status, or nursing care needs of nursing home residents with these conditions. The results of the study reported here, gathered from observations and interviews with nursing home residents and their caregivers, provide a first step in examining this increasingly important issue.

Short-stay nursing home rehabilitation patients: transitional care problems pose research challenges.

A clinical intervention pilot study to improve depression care for short-stay nursing home Medicare-reimbursed rehabilitation patients funded by the National Institute on Aging was conducted. Despite solid theoretical and clinical grounding and the support of a large nursing home company, several roadblocks to implementation were encountered, including involving patients and families, communication between providers, involving community primary care physicians, staff time constraints, and conducting research with short-stay patients. Although frustrating from a research standpoint, these roadblocks closely reflect problems identified by the American Geriatrics Society as impeding the delivery of high-quality transitional care in geriatrics. These research roadblocks are described as they were encountered in the clinical setting, and each is placed within the larger context of challenges associated with care transitions, especially for older persons with complex health needs receiving nursing home rehabilitation. Finally, recommendations are offered for researchers conducting much-needed research within geriatric transitional care settings, including starting early in the care transition chain and assisting patients and families with providing continuity across care settings.

Obesity in nursing homes: a critical review.

Obesity is a significant, and increasing, health problem for older individuals, their caregivers, and healthcare professionals and delivery systems, yet few studies document how nursing homes have responded to this epidemic. To address these gaps, an extensive electronic search was conducted in the Cumulative Index of Nursing and Allied Health, MedLine, PubMed, and the Cochrane Library using key terms and phrases, including obesity, morbid obesity, obesity in elderly, long-term care, bariatric or weight loss surgery, nursing care, and nursing homes. Subsequent critical review suggests that research on obesity in older adults has predominantly been conducted in community-dwelling populations and that few investigations have elucidated this problem in nursing home (NH) residents. Research priorities are also proposed to fill the current void in studies of obese NH residents.