Developing and testing a satisfaction survey for nursing home residents: the Ohio Experience

Input from consumers has become an important part of quality improvement in long-term care and for consumer decision-making. This paper documents the development of the Ohio Nursing Home Resident Satisfaction Survey (ONHRSS) through a partnership of state government, research, and industry experts. The instrument was tested and refined through two waves of data--a pretest phase and later with statewide data. Exploratory and confirmatory analyses with statewide data identified eight primary factors along with an underlying, secondary Global Satisfaction factor. Reliability of the domains ranged from .69 to .95. Recommendations for further refinement and testing of the instrument are discussed along with policy and practice implications.     

The life-course origins of mastery among older people

In this article, we aim to identify the sources of mastery--the understanding that individuals hold about their ability to control the circumstances of their lives. The sample for our inquiry was drawn from the Medicare beneficiary files of people 65 and older living in Washington, DC, and two adjoining Maryland counties. We find that past circumstances, particularly those reflecting status attainment and early exposure to intractable hardships, converge with stressors experienced in late life to influence elders' level of mastery. The impact of past conditions, however, does not necessarily directly affect the current mastery of older people. Instead, the effect of prior experiences on current mastery is mediated by what we refer to as life-course mastery: one's belief that one has directed and managed the trajectories that connect one's past to the present. Our analyses show that life-course mastery largely serves as the mediating channel through which individuals connect their past to their present.     

The production of therapy:the social process of construction of the mother of a sexually abused child

This study qualitatively examined the perspectives of clinical social workers on non-offending mothers of sexually abused children. The study examined whether clinicians still used collusion to explain mothers' behavior, despite research refuting collusion. Findings revealed that, although workers did not use collusion, they still constructed mothers negatively. Multiple contexts of agency practice influenced constructions. Administrative use of authority to implement external constraints led to workers' resistance, which involved humor with gender and ethnic components. The agency's role as a graduate social work teaching site contributed the following: Field instructors transmitted the belief that incest typified severe family difficulties and posed complex assessment and intervention problems. Implications for effective practice are discussed.     

The self-perceptions and interpersonal relationships of persons with significant physical disabilities: a qualitative pilot study

This exploratory, qualitative research was conducted to obtain the perspectives of people with significant physical disabilities regarding factors that have facilitated and hindered the development of a positive self-concept, participation in the broader society, and the formation of interpersonal relationships. The sample was high achieving in terms of education and/or career and attributed positive self-perceptions and their success in the broader society and interpersonal relationships to the attitudes and perceptions regarding their abilities, talents, and potential modeled in supportive family relationships. Females reported the influence of significant others most often, and males the effectiveness of their personality characteristics. Societal barriers, both practical and attitudinal, were reported along with the process for developing a positive selfperception despite these.     

Systemic lupus erythematosus and hormone replacement therapy

The indications for hormone replacement therapy (HRT) in postmenopausal women is the treatment of climacteric symptoms and the prevention of osteoporosis. Women with systemic lupus erythematosus (SLE) are more likely to have a premature menopause, osteoporosis and cardiovascular disease. HRT can induce SLE flares and cardiovascular or venous thromboembolic events. Therefore it should not be used in women with active disease or those with antiphospholipid (aPL) antibodies. In general, it should be used only for patients without active disease, a history of thrombosis or aPL antibodies. Non-oral administration of estrogen is recommended because of its lesser effect on coagulation. With regard to the progestogen, progesterone or pregnane derivatives are preferred. Otherwise, non-estrogen-based strategies should be used.     

Relocation stress syndrome in older adults transitioning from home to a long-term care facility: myth or reality?

Relocation stress syndrome is a nursing diagnosis characterized by symptoms such as anxiety, confusion, hopelessness, and loneliness. It usually occurs in older adults shortly after moving from a private residence to a nursing home or assisted-living facility. The primary purpose of this study was to validate the symptoms of relocation stress syndrome. Eight nursing home residents and 8 assisted-living facility residents were interviewed 2 to 10 weeks after admission, when symptoms of relocation stress syndrome are most likely to appear. Results of this study indicate that the incidence of relocation stress syndrome may be overestimated. More accurate diagnosis and treatment of depression in older adults is needed.