Evaluation of an intervention supporting breastfeeding among late-preterm infants during in-hospital stay

BackgroundLate-preterm infants show lower breastfeeding rates when compared with term infants. Current practice is to keep them in low-risk wards where clinical guidelines to support breastfeeding are well established for term infants but can be insufficient for late-preterm.ObjectiveThe aim of this study was to evaluate an intervention supporting breastfeeding among late-preterm infants in a maternity service in the Basque Country, Spain.MethodsThe intervention was designed to promote parents’ education and involvement, provide a multidisciplinary approach and decision-making, and avoid separation of the mother-infant dyad. A quasi-experimental study was conducted with a control (n = 212) and an intervention group (n = 161). Data was collected from clinical records from November 2012 to January 2015. Feeding rate at discharge, breast-pump use, incidence of morbidities, infant weight loss and hospital stay length were compared between the two groups.ResultsInfants in the control group were 50.7% exclusive breastfeeding, 37.8% breastfeeding, and, 11.5% formula feeding at discharge, whereas in the intervention group, frequencies were 68.4%, 25.9%, and 5.7%, respectively (p = 0.002). Mothers in the intervention group were 2.66 times more likely to use the breast-pump after almost all or all feeds and 2.09 times more likely to exclusively breastfeed at discharge. There were no significant differences in morbidities and infant weight loss between groups. Hospital stay was longer for infants who required phototherapy in the intervention group (p = 0.009).ConclusionThe intervention resulted in a higher breastfeeding rate at discharge. Interventions aimed to provide specific support among late-pretem infants in maternity services are effective.     

A longitudinal study of burnout: the relative importance of dispositions and experiences

This study investigated the relative contribution of personality vs. environmental factors to the genesis of the burnout syndrome. A sample of 221 nursing students in Hamburg, Germany, were administered a battery of personality measures prior to any training. They were later asked to rate various stressors encountered during their practical training on hospital wards and also in nursing school, general aspects of ward climate, the frequency of private life events, and their own well-being on standard measures of burnout. Data were collected at seven time points over a period of 3 years, including the initial assessment (T1-T7). Only complete data sets (N = 123) were used for the analyses. Burnout scores from T2 to T7 were predicted, on the one hand, by the 36 'dispositional' scales of the initial battery and, on the other hand, by a set of 18 'experience-oriented' scales from the later questionnaire's concurrent administration. Scales reflecting well-being were predicted better by experiences than by dispositions. With scales reflecting attitudes towards oneself and patients, respectively, it was the other way around. Thus, both dispositional and experiential views of burnout receive some support here. Intraindividual change in burnout scores could not be linked to dispositional or experiential variables.     

Examining the Nursing Home Physical Environment Through Policy-Driven Culture Change

A critical need exists to challenge approaches to nursing home care due to rigid organizational factors and hospital-like culture. It has been argued that resident care needs to move toward a person-centered approach by addressing the organizational, social, and physical environments in nursing home facilities, a process often known as culture change. In response to this need, the Centers for Medicare & Medicaid Services (CMS) has created funding for pay for performance (P4P) nursing home incentive programs to allow nursing home providers to receive CMS reimbursements for culture change in the facilities. Through care staff interviews, site observations, and a document review, this qualitative study assesses the impact of a Midwestern state P4P incentive program in three participating nursing homes. Using an environment and behavior (E-B) policy orientation framework, this study examines culture change through a focus on policy, the physical environment, place attachment, and social and psychological processes in the study settings.     

Family involvement in the institutional eldercare context. Towards a new understanding

This article focuses on family involvement and its various patterns and expressions in the context of end-of-life care in a nursing home. Based on analyses from an ethnographic study carried out at a nursing home ward, the aim is to describe and analyze the conditions of aging and dying for the old residents, as well as effects on their visiting families and relatives. As in similar research findings, it became clear from the study that families continue to visit and contribute to the care of the old resident throughout the years, from the time of placement to their demise, but that this involvement might vary both in content and in extent. However, it was found that families' involvement (as well as their changing relationships and roles) is particularly shaped by the very process of dying and lingering aura of death on the ward. The analysis presented in the article evinces the difficult — and in many ways impossible — role of the family in the institutional end-of-life setting, and discloses the various patterns and manifestations of family involvement in this environment. Different meanings and implications of family involvement are discussed and highlighted.     

Quality of Life in Nursing Homes

Abstract

The Nursing Home Reform Act (NHRA) of 1987 established nursing home requirements and dually emphasized quality of care and quality of life outcomes. We researched elders' perceptions of quality of life in nursing homes using focus groups. Analysis revealed four major themes important to residents: generativity, spiritual well-being, homelike environment, and privacy. Themes were used to analyze the disparity between NHRA's goal of dual emphasis and the dominance of quality of care in the treatment of frail elders living in nursing homes. Policies and procedures must be developed that promote decisional control in everyday matters of an older person's life.     

Incorporating quality into data envelopment analysis of nursing home performance: A case study

When using data envelopment analysis (DEA) as a benchmarking technique for nursing homes, it is essential to include measures of the quality of care. We survey applications where quality has been incorporated into DEA models and consider the concerns that arise when the results show that quality measures have been effectively ignored. Three modeling techniques are identified that address these concerns. Each of these techniques requires some input from management as to the proper emphasis to be placed on the quality aspect of performance. We report the results of a case study in which we apply these techniques to a DEA model of nursing home performance. We examine in depth not only the resulting efficiency scores, but also the benchmark sets and the weights given to the input and output measures. We find that two of the techniques are effective in insuring that DEA results discriminate between high and low quality performance.     

Effects of a multimodal activation program (SimA-P) in residents of nursing homes

Is it possible to maintain or even enhance functional and cognitive independence in residents of nursing homes? Little is known about the potentials and limits of therapeutic methods designed to maintain independence in elderly people already in need of residential nursing care. The aim of the “Rehabilitation in Nursing Homes” research project was to determine the practicability and effectiveness of a rehabilitative approach targeting residents of nursing homes. The main objectives of the activation program were to maintain and enhance residents’ cognitive and functional autonomy. Data on psychological, functional, and medical variables were obtained from a sample of 294 nursing home residents (age range?=?70–99 years) at three points of measurement over a 12-month period. The intervention approach draws on the theoretical and practical findings of the SimA Study (“Bedingungen der Erhaltung und Förderung von Selbstständigkeit im höheren Lebensalter,” “conditions on maintaining and supporting independent living in old age”; Oswald et al., Z. Gerontopsychol. Psychiatr., 15:61–84, 2002, Z. Gerontopsychol. Psychiatr., 15:13–31, 2002) and incorporates the results of recent therapeutic and rehabilitative studies in the fields of geriatrics and gerontopsychiatry. The intervention involves a combined program of cognitive and physical activation. An alternative program based on biographical information was designed specifically for residents with dementia. Results show that the intervention had significant effects on cognitive and functional parameters. Moreover, transfer effects were observed with respect to activities of daily living and frequency of falls.     

Does 'hardiness' predict adaptation to shiftwork?

This longitudinal study examined whether the dimensions of hardiness (commitment, control and challenge) predicted psychological symptoms and dissatisfaction with shiftwork, and whether or not the relationships identified were confounded with neuroticism and extraversion. Female nurses were studied during their first 15 months of shiftwork. Thirty-six nurses worked on a 2-shift (day and evening) schedule throughout and 66 transferred from the 2-shift schedule to a 3-shift (day, evening and night) schedule after 6 months. Hardiness, neuroticism, extraversion and symptoms were measured before the respondents began shiftwork (Stage 1). Symptoms and dissatisfaction were measured after 6 months (Stage 2) and 15 months (Stage 3). Multiple regressions indicated that the hardiness dimensions did not predict dissatisfaction at Stages 2 or 3, or symptoms at Stage 3. They also failed to buffer the effect of night-work on symptoms. However, commitment did predict symptoms at Stages 1 and 2 and challenge predicted symptoms at Stage 2. Although these effects were confounded with neuroticism, commitment showed weak evidence of independent prediction. In general, hardiness was a very poor predictor of shiftwork tolerance.