Decision-making influence: an empirical study of social workers in nursing homes.

Health care research on social workers' organizational influence has focused almost exclusively on the hospital setting. Little is known about social workers' influence in nursing homes, in particular organizational factors that support or constrain their impact on resident care. This article presents findings from a survey of 90 social workers employed in 53 nursing homes who identified their level of influence in five spheres of organizational decision making. With the exception of personnel decisions, there were few differences between the influence levels of the directors of social services and social workers without administrative responsibilities. Number of full-time-equivalent social workers, type of ownership, and length of employment of the director of social services were significantly related to the level of perceived influence held by the director of social services. The implications of these findings for social work practice in nursing homes are discussed.

Empowering organizational contexts: patterns and predictors of perceived decision-making influence among staff in nursing homes.

To examine staff members' self-perceived influence on decision making, data were collected from 498 staff in 51 nursing homes. Distinct patterns of perceived staff influence emerged for decisions related to direct resident care and those involving the personnel providing the care. Process variables, including nurse assistant involvement in shift report, frequency of unit staff meetings, and administrators' decision-making autonomy from the governing board, were significant predictors of individual and aggregate levels of perceived staff influence. Structural characteristics, including ownership type, number of beds in the facility, and number of facilities owned by the parent corporation were also related to staff's assessment of their decision-making influence.

Personal and environmental influences on nursing home satisfaction.

Data were collected from the administrator, staff, and a sample of 289 residents in 51 nursing homes in order to assess the influence of organizational factors on residents' satisfaction with the nursing home. Longevity of personnel, level of benefits, wages for nursing assistants and their perception of the charge nurse's fairness and competence as well as the degree of personalization of residents' rooms were all related to residents' satisfaction with the nursing home.

Interpersonal relationships of nursing home residents.

Interviews were conducted with 332 intellectually intact residents in 54 nursing homes to study their patterns of interpersonal relationships with staff, other residents, and family and friends outside the home. Results indicate the importance of having a close friend for residents' participation in activities, life satisfaction, and nursing home satisfaction.

The chronically mentally ill in nursing homes: issues in policy and practice.

The release of large numbers of patients from mental hospitals has resulted in the frequent placement of former mental patients in nursing homes. This study examines the integration of a sample of former patients into the residential facility itself and the community at large and concludes that the environment of the facility has a key impact on levels of residents' social integration.

Community integration of the mentally ill in residential facilities.

Much of the empirical research on the social adjustment of the mentally ill has focused on client variables. More recently, recognition of environmental factors as influences on behavior has led to attempts to determine environmental factors that may play a role in former mental patients' community integration. The secondary data analysis of 87 former state hospital patients in residential facilities suggests that while client characteristics are important in explaining community integration, facility, and community characteristics, particularly the level of skills training offered in the facility, size of city, and level of depersonalization of residents, have a significant impact. Results indicating the major importance of informal interactions between staff and clients are discussed, with implications for facility staff noted.

Milieu factors influencing patients' integration into community residential facilities.

Although much has been written on the importance of the environment as a therapeutic modality, few studies have examined the specific characteristics of community residential environments that influence the adjustment of the mentally ill. This study, based on a sample of 87 patients in Washington State, assesses the influence of patient, facility, and community characteristics on residents' integration within residential care facilities. The findings indicate that the type of facility, the number of daily living skills programmed, the rigidity of facility routines, the social distance between staff and residents, and the number of residents are significant predictors of residents' integration into facility life.

Predictors of self-sufficiency for the mentally ill in long-term care.

A growing interest of mental health professionals is the community adjustment of former mental hospital patients. Recognition of the influence of environmental factors on adjustment has led to attempts to determine the specific environmental factors that are influential. The present study of 87 former mental hospital patients in long-term care indicates that the type of management practices used, together with the facility director's attitudes toward social services are major predictors of clients self-sufficiency. Implications for administrators, staff and consultants to long-term care facilities are noted.

Blending administrative and community organization practice: the case of community residential facilities.

The authors discuss the management of community programs serving deinstitutionalized populations. They make a case for the concept of "community integration" (re-entry into society), arguing that translating the concept into meaningful practice requires clearer specification of the relevant client communities and calls for a blending of traditional administrative and community organizations skills, with resultant implications for social work education. Illustrations are drawn from the field of mental health and the needs of the chronically mentally ill.