Research in Gerontological Nursing

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Survey Research 

Know Thy Residents: An Exploration of Long-Term Care Nursing Staff’s Knowledge

Keith A. Anderson, PhD; Rebecca D. Taha, MS; Amy F. Hosier, PhD

Abstract

Nursing staff’s knowledge of residents’ lives in long-term care is critical to the provision of quality care, the formation of strong relationships between staff and residents, and the promotion of psychosocial well-being for residents. This study examines the degree to which nursing staff in assisted living facilities and nursing homes know residents in terms of their lives and occupations, family members, tastes and interests, and medical conditions. Quantitative surveys were administered to nursing staff-resident dyads (N = 199) as part of a larger study on quality of life in long-term care. Results indicated that while nursing staff generally knew residents fairly well, a significant percentage of nursing staff reported knowing nothing at all in each of the categorical areas of residents’ lives. Implications center on eliminating barriers to knowledge attainment and implementing educational interventions that may augment nursing staff’s knowledge of residents.

Abstract

Nursing staff’s knowledge of residents’ lives in long-term care is critical to the provision of quality care, the formation of strong relationships between staff and residents, and the promotion of psychosocial well-being for residents. This study examines the degree to which nursing staff in assisted living facilities and nursing homes know residents in terms of their lives and occupations, family members, tastes and interests, and medical conditions. Quantitative surveys were administered to nursing staff-resident dyads (N = 199) as part of a larger study on quality of life in long-term care. Results indicated that while nursing staff generally knew residents fairly well, a significant percentage of nursing staff reported knowing nothing at all in each of the categorical areas of residents’ lives. Implications center on eliminating barriers to knowledge attainment and implementing educational interventions that may augment nursing staff’s knowledge of residents.

Nursing staff in residential long-term care settings (i.e., assisted living facilities, nursing homes) are charged with a number of duties, ranging from the provision of physical nursing care to understanding and addressing the psychosocial needs of residents (American Geriatrics Society, 2004; Omnibus Budget Reconciliation Act, 1987). The notion of comprehensive care requires nursing staff to have a wealth of knowledge regarding each resident’s medical conditions, physical needs, psychological status, social history, and personal identity. This knowledge of residents equips nursing staff with the ability to treat the whole person.

Understanding and administering to the whole person has been linked to better outcomes in long-term care for older adults, most notably enhanced staff-resident relationships and higher levels satisfaction and well-being among staff, residents, and family members. On the other hand, failure to understand and treat the whole person has been found to be a primary concern for long-term care residents and their family members (Chen, Sabir, Zimmerman, Suitor, & Pillemer, 2007; Gaugler & Ewen, 2005; Gladstone & Wexler, 2000; Marquis, 2002). The purpose of this study is to gauge the knowledge levels of nursing staff, to examine whether disparities exist in knowledge levels according to knowledge type (e.g., personal information, medical information) and job type (e.g., RN versus nursing assistant [NA]), and to discuss targeted interventions that might be effective in augmenting knowledge levels in long-term care settings.

Background

Nursing theory is replete with notions of providing comprehensive care that addresses both the scientific and humanistic needs of patients. In Rogers’ (1970) seminal work, the art and science of nursing is accomplished by viewing patients as human beings, understanding how they interact with the environment, and providing compassionate care that reflects the unique nature of each individual. Along these same lines, humanistic nursing theory emphasizes the importance of the nurse-patient relationship and the essential nature of acquiring knowledge and understanding of the whole individual (Paterson & Zderad, 1976). Parse (1998) advanced this perspective by viewing knowledge as a tool with which nurses can join in the lives of patients, affirm the personal identities of patients, and work toward improving quality of life from the patients’ perspective.

In applying nursing theory to nursing practice in long-term care settings, it becomes clear that nursing staff must acquire both scientific knowledge (e.g., knowledge about residents’ medical conditions and physical needs) and humanistic knowledge (e.g., knowledge about residents’ personal lives) of each individual resident to provide comprehensive, holistic care. The question remains, however, whether the art and science of nursing are evident in the care of residents of long-term care facilities. The answer appears to be both yes and no.

Long-term care facilities have traditionally been founded on the medical model of care, which focuses on providing for physical and medical needs and tends to neglect the psychosocial needs of residents (Estes & Binney, 1991; Olson, 2003). This model of care is evident, for example, in Gubrium’s (1975) classic work in which nursing staff’s focus on “bed and body work” effectively reduces nursing home residents to objects, rather than human beings. Despite recent attempts to shift to social models of care that de-emphasize the institutional environment, researchers have continued to find that the physical and medical needs of long-term care residents typically take precedence over their psychosocial needs (Harr & Kasayka, 2000; Kane, 2001; Pietrukowicz & Johnson, 1991). This may be understandable given the high workloads of nursing staff, the increasing complexity and acuity of medial conditions and treatments, and the time-consuming paperwork associated with the job. Nonetheless, failing to understand and address residents’ psychosocial needs can dehumanize them, stripping them of their individuality and identity.

In contrast to these findings, other researchers have found that nursing staff and long-term care residents can and do form very close bonds, metaphorical to relationships shared between family members (Berdes & Eckert, 2007; Moss, Moss, Rubenstein, & Black, 2003). This finding is not unexpected, considering the amount of time nursing staff and residents spend together and the high level of intimacy involved in the care provided. These relationships impact perceived quality of care and have been reported as an important determinant of overall satisfaction with care for both residents and family members (Gaugler & Ewen, 2005; Gladstone & Wexler, 2000).

Because knowledge of the individual is a central building block of relationships, these findings would lead one to believe that nursing staff have a relatively sound understanding and knowledge base for each individual resident. However, researchers have yet to explicitly measure nurses’ knowledge levels regarding the specific residents under their care. This study represents the first step in understanding the degree to which nurses know their residents and should provide a nascent foundation for future studies that could link staff knowledge with important quality of care indicators.

Study Focus and Research Questions

The focus of the current study was to measure and compare the knowledge levels of long-term care nursing staff in four basic areas:

  • Historical aspects of residents’ lives (e.g., prior occupation).
  • Residents’ family members.
  • Residents’ current interests, preferences, and tastes.
  • Residents’ medical conditions and plans of care.

As this study is exploratory and descriptive in nature, we chose to develop and address research questions rather than test hypotheses. The following questions were explored.

Research Question 1

For the first research question, we asked, “Do nursing staff in long-term care facilities have a basic working knowledge regarding residents’ histories, families, interests and preferences, and medical conditions and care plans?” For the purpose of this study, basic working knowledge was defined as having at least some knowledge regarding different areas of residents’ lives. As shown in the previously discussed literature on staff-resident relationships, it is unclear as to whether nursing staff have or lack a basic working knowledge of residents. Addressing this question will help better understand the degree to which nursing staff know the residents who are in their care.

Research Question 2

The second research question was, “Do differences exist in levels of knowledge according to job type? More specifically, are there differences in knowledge levels between RNs, licensed practical nurses (LPNs), and NAs across the different knowledge categories?” This question is raised because there are significant differences in the training and duties of these different levels of nursing staff. For example, RNs and LPNs receive much higher levels of training about the medical and physical care of residents, compared with the minimal training received by NAs. On the other hand, NAs might be expected to have greater knowledge of the humanistic aspects of residents’ lives, as they typically spend the greatest amount of face-to-face time with residents. NAs provide the majority of the face-to-face care with residents and, as one study of nursing staff in nursing homes found, three to four times the amount of time spent with residents compared with RNs and LPNs (U.S. General Accounting Office, 2002).

Method

Sample

The sample for this study was drawn from the University of Kentucky Institutional Permeability in Long-Term Care Study, which examined the exchange of information and communication between long-term care facilities and the community. Prior to beginning any data collection, approval to proceed was granted through the Institutional Review Board. Assisted living facilities and nursing homes were randomly selected from the state long-term care directory and contacted via letters and telephone calls to secure consent to participate in the study. The final sample of facilities consisted of 32 nursing homes and 27 assisted living facilities located within the Commonwealth of Kentucky.

Following facility selection, residents were randomly selected and asked to participate in the study. Facility administrators then identified the staff members who provided care for this group of residents. Only staff members who were described as having significant roles in the care of these residents were included in the sample. The final sample of participants consisted of 199 nursing staff members (39 RNs, 19 LPNs, 141 NAs) who reported on 199 residents, resulting in 199 staff-resident dyads (N = 199).

It should be noted that this sample is actually a smaller subsample of the larger study; hence, the relatively low number of participants per facility. Demographically, nursing staff members were typically Caucasian (88%), in their late 30s (mean age = 39), high school graduates or above (78.1%), and employed for a least 1 year in their current facility (92%). Residents were typically Caucasian (94%), in their late 70s and early 80s, and had been living in their facilities for an average of 2 to 3 years (Table 1).

Nursing Staff and Resident Characteristics

Table 1: Nursing Staff and Resident Characteristics

Measures

Because this study was exploratory in nature, the measures used to gauge the knowledge levels of nursing staff consisted of four simple items that were intentionally broad in scope. Nursing staff were asked the following questions about the specific resident(s) for whom they provided care:

How knowledgeable are you regarding:

  1. the resident’s life and occupation before admission?

  2. the resident’s family?

  3. the resident’s tastes and interests?

  4. the resident’s medical condition and care plan?

Items 1 through 3 were designed to gauge nursing staff’s knowledge regarding the personal identity of residents (i.e., humanistic knowledge). For example, a resident may describe herself as a former teacher, widow, mother of two, and grandmother of five who enjoys playing bridge and taking walks. Item 4 was designed to gauge nursing staff’s knowledge of the resident’s specific diagnoses and the prescribed actions designed to meet specific care needs (i.e., scientific knowledge). Responses to each of the four items were recorded on a 4-point Likert scale where 1 = very well, 2 = well, 3 = some, and 4 = not at all.

Data Analysis

Data were collected by the University of Kentucky Survey Research Center via telephone interviews and entered into a computer-assisted telephone interviewing (CATI) system developed using wInquiry® (ARS, Inc., Evansville, IN). This system allowed interviewers to ask questions, enter data, and code data simultaneously.

Data were analyzed using SPSS version 15.0 and SAS version 9.1. Descriptive statistics were generated to gauge the levels of knowledge that each group of nurses (RNs, LPNs, and NAs) had regarding each survey item. Binomial tests for proportion were conducted to explore the levels of knowledge that staff members reported about residents’ lives across the four domains of knowledge. Specifically, we tested the assumption that all nursing staff would report having at least some knowledge about residents across the different knowledge types. To determine whether knowledge level distributions differed among the three job types, nonparametric Kruskal-Wallis tests were performed (Rosner, 2000).

Results

In the first research question, we asked whether nursing staff had a basic working knowledge regarding residents’ histories, families, interests and preferences, and medical conditions and care plans. Again, basic working knowledge was defined in this study as having at least some knowledge regarding the different aspects of residents’ lives. As indicated in Table 2, we found that a significant proportion (p < 0.05) of nursing staff did not have a basic working knowledge regarding the lives of the residents in their care. When asked about how well they knew about the life and occupation of each specific resident prior to admission, 33.2% of the participants responded not at all (overall mean response = 2.1, SD = 1, range = 1 to 4). When asked about their knowledge levels regarding residents’ family members, 22.6% of the overall sample responded not at all (overall mean response = 2.3, SD = 1, range = 1 to 4). When asked how well participants knew each specific resident’s tastes and interests, 7.5% of the overall sample responded not at all (overall mean response = 2.8, SD = 0.9, range = 1 to 4). Finally, when asked how well participants knew each specific resident’s medical conditions and care plans, 10.1% of the overall sample responded not at all (overall mean response = 2.3, SD = 1, range = 1 to 4).

Nursing Staff Knowledge Levels

Table 2: Nursing Staff Knowledge Levels

In the second research question, we queried whether differences would exist in levels of knowledge according to job type. We found that no significant differences were found between the different levels of nursing staff regarding knowledge of residents’ lives and occupations (χ2 = 1.927, p = 0.382), family members (χ2 = 0.563, p = 0.755), and tastes and interests (χ2 = 2.691, p = 0.260). Significant differences were found, however, between different levels of nursing staff regarding their knowledge of residents’ medical conditions and plans of care (χ2 = 20.620, p < 0.001). RNs and LPNs were found to have significantly higher levels of knowledge about residents’ medical conditions and care plans than NAs.

Discussion

In this study, we examined the degree to which nursing staff in long-term care settings (nursing homes and assisted living facilities) know the residents who are under their care. Specifically, we measured and compared each level of nursing (RNs, LPNs, and NAs) in terms of their knowledge of residents’ past lives and occupations, family members, tastes and interests, and medical conditions and plans of care. Across the different knowledge categories, results indicated that a significant number of nursing staff reported knowing nothing at all about the residents in their care. In reference to our second research question, significant differences were not found between levels of nursing staff in terms of their knowledge about residents’ personal lives; however, significant differences were found in terms of their medical knowledge.

A significant number of nursing staff members responded not at all when asked about how well they knew about the humanistic aspects of residents’ lives, including information about family members, past occupations, and interests. As mentioned above, an individual’s past is an important component of personal identity, particularly for older adults. Supporting and fostering the maintenance of personal identity is critical in the often dehumanizing environment of long-term care (Harr & Kasayka, 2000). Identity is often closely related to family life and the relationships individuals have with their family members. In the nursing home setting, it has been found that family members continue to play active roles in the lives of residents and are central to residents’ well-being (Gaugler, 2005). The finding that a significant number of staff knew very little about residents’ families is troubling, considering the centrality and importance of family relationships.

Residents’ tastes and interests are also an important component of personal identity, particularly for residents who have cognitive challenges, such as memory loss (Kolanowski & Rule, 2001). Being able to anticipate and meet the tastes and interests of residents may also be a factor in supporting their emotional, social, and physical well-being. Individualized care that reflects residents’ preferences across a spectrum of areas (e.g., sleep patterns and preferences, food choices, social activities) is central in care planning. Knowledge of residents’ tastes and preferences logically precludes meeting these tastes and interests, and it is hard to imagine that staff members who answered not at all were equipped or inclined to do so.

With regard to the scientific knowledge of nursing staff, more than 10% of participants reported knowing nothing at all about the medical conditions and care plans for residents who were under their care. At the most fundamental level, it would be expected that nursing staff would have at least a basic understanding of residents’ diagnoses and plans of care, as this knowledge base should serve as the rationale for much of their daily actions. For example, if a resident has a history of cerebrovascular accidents (CVAs), nursing staff should understand that the resident may have impaired memory or difficulty swallowing (Ackley & Ladwig, 2008), conditions which require a special plan of care. Without knowledge of the diagnosis or the plan of care, it would seem impossible to meet the resident’s care needs or recognize and understand changes in status (i.e., if additional CVAs occur). This finding was particularly unexpected and somewhat disturbing, considering the centrality and importance of this kind of knowledge in the provision of quality care.

The finding that significant differences existed between levels of nursing staff in terms of their medical knowledge of residents only partially reflects our expectations. We had expected RNs and LPNs to have higher levels of medical knowledge compared with NAs due to differences in training and degrees of access and familiarity with the medical charts. On the other hand, we had anticipated that NAs would report higher levels of knowledge about residents’ personal lives, family members, and tastes and preferences due to their higher level of interaction with residents. This was not the case, as NAs reported lower levels of knowledge than RNs and LPNs across the three domains of humanistic knowledge. Again, access and familiarity with the medical charts may partially explain this finding. Medical charts often contain psychosocial assessments and personal histories of residents, and NAs may lack access and time to review these documents. This finding also raises questions about the kinds of interactions NAs have with residents. Are they engaging the residents on a personal level, or are they simply maintaining surface-level relationships? This is unclear, but there are interventions and ways in which the knowledge levels of all nursing staff can be enhanced.

Practice Implications

The findings from this study indicate that a significant portion of nursing staff in long-term care facilities may lack important information about the residents under their care. On the basis of these findings, we can surmise that information is either not being collected adequately or not being disseminated effectively. Fortunately, there are several simple steps that facilities can take to improve the collection and dissemination of information about residents, which may, in turn, increase nursing staff’s knowledge levels.

First and foremost, every level of nursing staff should have access to residents’ medical charts. However, anecdotal evidence suggests that some facilities limit access to upper-echelon nursing staff (e.g., RNs, LPNs), thereby denying NAs access to this essential information. Medical charts contain not only the scientific knowledge that nurses need to meet the physical needs of residents, but also other important information, such as advanced directives and powers of attorney. Some facilities also include detailed psychosocial histories of residents in their medical charts that include “resident’s preferences” and “cultural, racial, religious, and ethnic background and sexual orientation, and implications for the care plan” (National Association of Social Workers, 1993, p. 3). Research has found that comprehensive psychosocial histories may allow personnel in long-term care facilities to better understand behavior and improve overall quality of care (Kolanowski & Rule, 2001). In addition to expanding the detailed information collected on residents, facilities might also consider including a brief synopsis of each resident that could be perused by nursing staff prior to working with residents. It is anticipated that these changes in access to and dissemination of information would be cost effective and easily implemented, yet future studies are needed to determine their efficacy.

Nursing staff may also be able to enhance their knowledge of residents on an informal basis. At times, staff members in long-term care facilities are so acutely focused on accomplishing the many physical tasks of care that they fail to engage and interact with residents (Gubrium, 1975; Olson, 2003). Nursing staff should be encouraged to engage residents in conversation during care and may find that getting to know their residents can facilitate accomplishment of their work (Asmuth, 2004; Burgio et al., 2001).

Improving relationships between nursing staff and family members may also be a key to improving the informal collection of information. Family members often have a wealth of “insider information” about the residents and may be eager to share this knowledge with staff. A number of effective programs (e.g., Family Involvement in Care, Partners in Caregiving) exist to improve staff-family relationships (Robison & Pillemer, 2005; Specht, Reed, & Maas, 2005), which can help nursing staff learn more about residents’ lives.

Finally, informal knowledge about residents could be augmented through the use of brief biographies that are posted outside each resident’s room. These biographies can be developed jointly by residents, family members, and staff, and could contain casual information about past occupations, past and current interests, and family life (Clarke, Hanson, & Ross, 2003; Pietrukowicz & Johnson, 1991). These visual cues may serve a dual purpose in educating staff members and visitors and reorienting residents with memory problems, similar to the use of memory boxes (e.g., Russell & Richards, 2005).

From a management perspective, senior nursing staff (e.g., RNs, Directors of Nursing) in key leadership positions may be able to institute communication and learning programs in the nursing home that facilitate the enhancement of staff knowledge. Nursing homes are complex organizational systems that rely on strong communication and relationships between different disciplines and levels within disciplines. Researchers have found that strong leadership from senior nursing home staff in terms of communication and interactional patterns are linked with better resident outcomes (Anderson, Issel, & McDaniel, 2003).

Within this context of communication, it is certainly conceivable that senior nursing staff could enhance nursing staff’s knowledge about residents, particularly in terms of residents’ medical needs and plans of care. Structured programs led by senior nursing staff could focus on the transmission of information about residents and encourage nursing staff to actively engage residents with the explicit purpose of getting to know their “clients” better. Despite the benefits of interactional leadership and enhanced communication, this tends to be an area in need of improvement in the nursing home setting (Scott-Cawiezell et al., 2004). Senior nursing staff and management should explore ways they can improve leadership and communication, thereby building a community of authentic partnerships that facilitate learning and care (Labonte, 2005).

Limitations

There are several limitations to this study that should be recognized. First, the overall sample for this project was relatively small, and there was significant variation in the sample sizes in each job category (RNs = 39, LPNs = 19, NAs = 141). This limits our ability to generalize this sample to the overall population of RNs and LPNs. Future studies may choose to oversample RNs and LPNs to create a more balanced and generalizable sample.

Second, the sample was not fully representative of the overall population of nurses in terms of race and ethnicity. The sample was predominantly Caucasian (88%) and contained relatively few African American (8%) and Hispanic (1%) individuals. The overall population of nurses is much more diverse in terms of race and ethnicity. For example, the race/ethnicity of NAs working across all health care settings has been estimated at approximately 48% Caucasian, 35% African American or Black, 13% Hispanic or Latino, and 4% Asian (U.S. Department of Labor, Bureau of Labor Statistics, 2007). Again, a more representative sample in terms of race/ethnicity would increase our ability to generalize findings to the overall population.

Limitations also existed in the rather rudimentary measure used to gauge knowledge levels. The measure consisted of only four items, and the responses available were relatively vague and difficult to quantify (e.g., the response some). Additional items and more refined response categories would have resulted in data that were richer and more readily interpreted. Finally, it may have been more important to examine the length of time each of the nursing staff had worked with each specific resident, rather than length of time on the job. Length of relationship should be considered as a covariate in future studies.

Future Research Directions

This study was exploratory in nature, thus the findings are better suited to direct future studies than to reach firm conclusions regarding the knowledge levels of nursing staff in long-term care. In future studies, researchers should rely less on participants’ perceived levels of knowledge and more on the actual knowledge participants possess. Nursing staff could be asked to report specifically about the lives and care of residents. It may be the case that nursing staff report knowing nothing at all, when in actuality they do possess certain knowledge about a resident that may or may not be reflected in a care plan or contained with an arbitrary knowledge category. For example, NAs may know about the sleeping schedules of residents and not consider this to be contained within a specified plan of care. The use of open-ended questions and qualitative methods may be a better way to gauge nursing staff’s actual knowledge and understanding of residents.

Intervention studies may also be an appropriate next step in the progression of research. Rather than seeking to simply identify deficiencies, researchers and practitioners may be better served by identifying areas for improvement, instituting targeted interventions, and discovering ways to augment nursing staff’s knowledge and understanding of residents. This study represents a first step in that process, and we encourage researchers to further investigate this important aspect of long-term care.

Conclusion

Mandates calling for holistic care in long-term care facilities dictate that nursing staff address both the physical and psychosocial needs of residents. This requires nursing staff to have scientific, as well as humanistic, knowledge of the residents under their care. The findings from this study paint a rather troubling picture of the state of knowledge of nursing staff in long-term care and indicate that these mandates have yet to be fully answered. Rather than serving as an indictment, these findings should stand as a direction marker, guiding long-term care facilities toward change and improvement. Through relatively simple and cost-effective measures, facilities may be able to improve the collection and dissemination of information about residents’ lives. In doing so, nursing staff may be better equipped to provide for the needs of residents and to meet both the scientific and humanistic callings of the nursing profession.

References

  • Ackley, BJ & Ladwig, GB(Eds.). 2008. Nursing diagnosis handbook: An evidence-based guide to planning care (8th ed) St Louis: Mosby/Elsevier.
  • American Geriatrics Society. (2004, May). Assisted living facilities position statement. Retrieved November 12, 2008, from http://www.americangeriatrics.org/products/positionpapers/ags_alf.shtml
  • Anderson, RA, Issel, LM & McDaniel, RR Jr. . 2003. Nursing homes as complex adaptive systems: Relationships between management practice and resident outcomes. Nursing Research, 52, 12–21.
  • Asmuth, MV2004. Developing and sustaining interpersonal relationships between certified nursing assistants and residents in long-term care facilities (Doctoral thesis, University of South Florida, 2004). Dissertation Abstracts International, 65(03),764.
  • Berdes, C & Eckert, JM2007. The language of caring: Nurse’s aides’ use of family metaphors conveys affective care. The Gerontologist, 47, 340–349.
  • Burgio, LD, Allen-Burge, R, Roth, DL, Bourgeois, MS, Dijkstra, K & Gerstle, J et al. . 2001. Come talk with me: Improving communication between nursing assistants and nursing home residents during care routines. The Gerontologist, 41, 449–460.
  • Chen, CK, Sabir, M, Zimmerman, S, Suitor, J & Pillemer, K2007. The importance of family relationships with nursing facility staff for family caregiver burden and depression. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 62, P253–P260.
  • Clarke, A, Hanson, EJ & Ross, H2003. Seeing the person behind the patient: Enhancing the care of older people using a biographical approach. Journal of Clinical Nursing, 12, 697–706. doi:10.1046/j.1365-2702.2003.00784.x [CrossRef]
  • Estes, CL & Binney, EA1991. The biomedicalization of aging: Dangers and dilemmas. In Minkler, M & Estes, CL (Eds.), Critical perspectives on aging: The political and moral economy of growing old (pp. 117–134). Amityville, NY: Baywood.
  • Gaugler, JE (Ed.). 2005. Promoting family involvement in long-term care settings: A guide to programs that work Baltimore: Health Professions Press.
  • Gaugler, JE & Ewen, HH2005. Building relationships in residential long-term care: Determinants of staff attitudes toward family members. Journal of Gerontological Nursing, 31(9),19–26.
  • Gladstone, J & Wexler, E2000. A family perspective of family/staff interaction in long-term care facilities. Geriatric Nursing, 21, 16–19. doi:10.1067/mgn.2000.105792 [CrossRef]
  • Gubrium, JF1975. Living and dying at Murray Manor. London: St. Martin’s Press.
  • Harr, R & Kasayka, R2000. The power of place and the preservation of personhood. Nursing Homes and Long-Term Care Management, 9(6),30–35.
  • Kane, RA2001. Long-term care and a good quality of life: Bringing them closer together. The Gerontologist, 41, 293–304.
  • Kolanowski, AM & Rule, RA2001. The way we were: Importance of psychosocial history in the care of older persons with dementia. Activities, Adaptation, & Aging, 26(2),13–27.
  • Labonte, R. 2005. Community, community development, and the forming of authentic partnerships. In Minkler, M (Ed.), Community organizing & community building for health (pp. 82–115). New Brunswick, NJ: Rutgers University Press.
  • Marquis, R2002. Quality in aged care: A question of relational ethics?Australasian Journal on Ageing, 21, 25–29. doi:10.1111/j.1741-6612.2002.tb00411.x [CrossRef]
  • Moss, MS, Moss, SZ, Rubenstein, RL & Black, HK2003. The metaphor of “family” in staff communication about dying and death. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 58, S290–S296.
  • National Association of Social Workers. (1993, April). NASW clinical indicators for social work and psychosocial services in nursing homes. Retrieved August 31, 2007, from http://www.socialworkers.org/practice/standards/nursing_homes.asp
  • Olson, LK2003. The not-so-golden years: Caregiving, the frail elderly, and the long-term care establishment Lanham, MD: Rowman and Littlefield.
  • Omnibus Budget Reconciliation Act of 1987. Pub. L. No. 100-203. Subtitle C: Nursing home reform 1987.
  • Parse, RR1998. The human becoming school of thought: A perspective for nurses and other health professionals Thousand Oaks, CA: Sage.
  • Paterson, JG & Zderad, LT1976. Humanistic nursing New York: Wiley & Sons.
  • Pietrukowicz, ME & Johnson, MM1991. Using life histories to individualize nursing home staff attitudes toward residents. The Gerontologist, 31, 102–106.
  • Robison, J & Pillemer, KA2005. Partners in caregiving: Cooperative communication between families and nursing homes. In Gaugler, JE (Ed.), Promoting family involvement in long-term care settings: A guide to programs that work (pp. 201–224). Baltimore: Health Professions Press.
  • Rogers, ME1970. An introduction to the theoretical basis of nursing. Philadelphia: Davis.
  • Rosner, B. 2000. Fundamentals of biostatistics (5th ed) Pacific Grove, CA: Duxbury.
  • Russell, MP & Richards, M2005. Memory boxes unlock memories and form relationships. Activities Directors’ Quarterly for Alzheimer’s & Other Dementia Patients, 6(4),11–21.
  • Scott-Cawiezell, J, Schenkman, M, Moore, L, Vojir, C, Connoly, RP & Pratt, M et al. 2004. Exploring nursing home staff’s perceptions of communication and leadership to facilitate quality improvement. Journal of Nursing Care Quality, 19, 242–252.
  • Specht, JKP, Reed, D & Maas, ML2005. Family involvement in the care of residents with dementia: An important resource for quality of life and care. In Gaugler, JE (Ed.), Promoting family involvement in long-term care settings: A guide to programs that work (pp. 163–200). Baltimore: Health Professions Press.
  • US Department of Labor, Bureau of Labor Statistics. 2007. Employed persons by detailed occupation, sex, race, and Hispanic or Latino ethnicity. In Labor force statistics from the current population survey. Retrieved August 29, 2007, from http://www.bls.gov/cps/cpsaat11.pdf
  • U.S. General Accounting Office. (2002, November). Report to Congressional Committees: Skilled nursing facilities (Publication No. GAO-03-176). Retrieved August 21, 2007, from http://gao.gov/new.items/d03176.pdf

Nursing Staff and Resident Characteristics

Characteristic Value
Nursing staff (n = 199)
Number of facilities by type
  Nursing home 32
  Assisted living facility 27
Number of participating staff by job type
  RN 39
  Licensed practical nurse 19
  Nursing assistant 141
Educational level
  Did not complete high school 21.9%
  High school graduate/GED 41.8%
  Vocational/technical degree 14.3%
  College degree 22%
Race/ethnicity
  Caucasian 88%
  African American 8%
  Hispanic 1%
  Other 1%
Mean age (years) 39
Length of employment
  Less than 1 year 8%
  1 or more years 92%
Residents (n = 199)
Mean age (years)
  Nursing home 77
  Assisted living facility 82
Race
  Caucasian 94%
  African American 6%
Mean length of stay (months)
  Nursing home 34.5
  Assisted living facility 24.3

Nursing Staff Knowledge Levels

Knowledge Category Response (%)
Very Well Well Some Not at All
Life and occupation
  RNs 15.4 20.5 41 23.1
  LPNs 5.3 15.8 47.4 31.6
  NAs 12.8 17.7 33.3 36.2
  Overall sample 12.5 18.1 36.2 33.2*
Family members
  RNs 12.8 20.5 51.3 15.4
  LPNs 26.3 5.3 52.6 15.8
  NAs 13.5 22 39 25.5
  Overall sample 14.6 20.1 42.7 22.6*
Tastes and interests
  RNs 20.5 53.9 23.1 2.6
  LPNs 21.1 15.8 63.2 0
  NAs 26.2 29.8 34 9.9
  Overall sample 24.6 33.2 34.7 7.5*
Medical condition and care plan
  RNs 28.2 61.5 7.7 2.6
  LPNs 26.3 68.4 5.3 0
  NAs 17 34.8 26.6 13.5
  Overall sample 20.1 43.2 26.6 10.1*
Authors

Dr. Anderson is Assistant Professor, The Ohio State University, College of Social Work, Columbus, Ohio; Ms. Taha is a doctoral candidate, University of Kentucky, Graduate Center for Gerontology, and Dr. Hosier is Assistant Professor, University of Kentucky, School of Human Environmental Sciences, Lexington, Kentucky.

This study was supported by a grant from the Agency for Healthcare Research and Quality (5 RO1 HS013181-03) awarded to Dr. Joseph E. Gaugler of the University of Minnesota and Dr. Graham D. Rowles of the University of Kentucky. The authors acknowledge the leadership, wisdom, and generosity of Dr. Gaugler and Dr. Rowles.

Address correspondence to Keith A. Anderson, PhD, Assistant Professor, The Ohio State University, College of Social Work, 1947 N. College Road, Columbus, OH 43210-1162; e-mail: anderson.1630@osu.edu.

10.3928/19404921-20090101-03

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