Linking level of care to level of need: Assessing the need for mental health care for nursing home residents.

What are the mental health status and active treatment needs of nursing home residents? A stratified random sample of 828 residents in 25 facilities serving Medicaid recipients was assessed for levels of physical and psychosocial functioning. Although 91.2% had sufficiently high levels of medical and physical care needs to justify nursing home placement, 79.6% also had moderate to intense needs for mental health care. Older residents, relative to their younger counterparts, had more intense medical and mental health care needs. It was also found that psychiatric diagnosis was a poor indicator of mental health service needs, particularly among elderly individuals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reflecting on the knowledge used when caring for an intensive care patient and his/her family

Carper's four ways of knowing are used to structure a reflection on the knowledge used by an associate nurse in intensive care when caring for her patient, his wife and son. John, the patient, had previously undergone a sex change operation as well as cardiac surgery. His current period in intensive care was due to pancreatitis and involved numerous returns to theatre. He eventually died following multi-organ failure. The reflection focuses on the associate nurse's feelings when trying to act as an advocate for both John and his wife at the time of the patient's pending death.     

An experimental study of the relation between nursing care and patient welfare.

4 experiments were conducted in an ongoing hospital setting to test the hypothesis that increasing the amount and quality of nursing care would produce improvements in patient welfare. Changes introduced on experimental wards consisted of increasing the size of the nursing staff, conducting inservice-education programs, and combining increased staffing and inservice education. With the exception of a reduction in patient complaints during 1 experiment, no improvement in patient welfare was produced. Results suggest that there is a limit to the contribution which nursing can make to patient welfare and that this limit is much closer to the existing level of care than was formerly thought. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Heart transplantation and the nursing care of transplant patient]

Cultural and religious beliefs in Jordan do not allow male nursing students to practice in the female patients' wards, especially in maternity units. Yet a maternal and infant care nursing course is a required component of Jordan's four-year undergraduate nursing curriculum. Below, how a maternal/infant care course specific for male nursing students with the aim of teaching related but culturally appropriate nursing skills was developed.     

Intensive care 1980-1995: change in patient characteristics, nursing workload and outcome

OBJECTIVE: To assess temporal changes in patient characteristics, nursing workload and outcome of the patients and to compare the actual amount of available nursing staff with the estimated needs in a medical-surgical ICU. DESIGN: Retrospective analysis of prospectively collected data. SETTING: A medical-surgical adult intensive care unit (ICU) in a Swiss university hospital. PATIENTS: Data of all patients staying in the ICU between January 1980 and December 1995 were included. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The estimated number of nurses needed was defined according to the Swiss Society of Intensive Care Medicine (SGI) grading system: category I = one nurse/patient/shift (= 8 h), category II = one nurse/two patients/shift, category III = one nurse/three patients/shift. An intervention score (IS) was obtained, based on a number of specific activities in the ICU. There was a total of 35,327 patients (32% medical and 68% postoperative/trauma patients). Over time, the number of patients per year increased (1980/1995: 1,825/2,305, p < 0.001) and the length of ICU stay (LOS) decreased (4.1/3.8 days, p < 0.013). There was an increase in the number of patients aged > 70 years (19%/28%, p < 0.001), and a decrease in the number of patients < 60 years (58%/41%, p < 0.001). During the same time period, the IS increased two-fold. Measurement of nursing workload showed an increase over time. The number of nursing days per year increased (1980/1995: 7454/8681, p < 0.019), as did the relative amount of patients in category I (49%/71%, p < 0.001), whereas the portion of patients in category II (41%/28%, p < 0.019) and category III (10%/0%) decreased. During the same time period, mortality at ICU discharge decreased (9.0%/7.0%, p < 0.002). CONCLUSIONS: During the last 16 years, there has been a marked increase in workload at this medical-surgical ICU. Despite an increase in the number of severely sick patients (as defined by the nursing grading system) and patient age, ICU mortality and LOS declined from 1980 to 1995. This may be ascribed to improved patient treatment or care. Whether an increasingly liberal discharge policy (transfer to newly opened intermediate care units, transfer of patients expected to die to the ward) or a more rigorous triage (denying admission to patients with a very poor prognosis) are confounding factors cannot be answered by this investigation. The present data provide support for the tenet that there is a trend toward more complex therapies in increasingly older patients in tertiary care ICUs. Calculations for the number or nurses needed in an ICU should take into acount the increased turnover of patients and the changing patient characteristics.     

Coaching at the top: Assisting a chief executive and his team.

Coaching at the executive level of organizations most often includes a blend of individual, team, and organizational interventions. As psychologists, traditions lead us to rely heavily on our unique expertise in individual assessment and treatment in working for organizational change. To explore the limits of this tradition, this case study reports on an action research experiment in which strategy-driven group-level interventions were used exclusively to drive both individual and team change. It is proposed that the definition of coaching be expanded to include actions taken to enable a team to be self-correcting and self-learning without direct counseling from the coach. The article reviews the step-by-step process that enabled the executive team to self-design the new global organization in alignment with their strategy. Attention is drawn to the organizational assessment and feedback processes used at multiple points in the engagement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationships among team ability composition, team mental models, and team performance.

This study examined the relationship between the similarity and accuracy of team mental models and compared the extent to which each predicted team performance. The relationship between team ability composition and team mental models was also investigated. Eighty-three dyadic teams worked on a complex skill task in a 2-week training protocol. Results indicated that although similarity and accuracy of team mental models were significantly related, accuracy was a stronger predictor of team performance. In addition, team ability was more strongly related to the accuracy than to the similarity of team mental models and accuracy partially mediated the relationship between team ability and team performance, but similarity did not. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dementia, agitation, and care in the nursing home

OBJECTIVE: To examine the behavioral and functional problems of the cognitively impaired. DESIGN: A survey of a cohort of residents from six nursing homes. PARTICIPANTS: Subjects were randomly selected based on a minimum age of 70 years and a Resource Utilization Group (RUG) classification of the Physical or Behavioral type. Of those eligible, 44% (n = 366) agreed to participate. The participants and non-participants had similar demographics except for a higher incidence of mental illness in the non-participant group, which did not have a significant impact on agitation. SETTING: Six nursing homes in New York City, three voluntary non-profit and three proprietary. MEASUREMENT: The study used chart review, assessment of residents' cognitive and functional abilities, nursing assistants' ratings of residents' functional abilities, behavioral problems, and the amount of effort required in care, and time-motion observations of staff-resident interactions. RESULTS: Residents' level of cognitive impairment had a significant impact on problem behaviors during ADL tasks, along with supervision required in patient care (P < 0.05). These results were validated by time-motion analysis. Regression analysis revealed that for non-demented subjects, the best indicator of care needs was health status, while for demented residents the best indicator was cognitive status (P < 0.0001). CONCLUSIONS: The care needs of residents with dementia are better estimated by a mental status test for cognitive impairment then by ADL assessment alone. Greater agitation is associated with increasing cognitive impairment. Further, agitation and behavioral problems associated with care result in a need for increased staff supervision.