College of Health Professions
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Item A Focus Group Study of Perceptions of Quality of Care Among Nurses in Nursing Homes(2010-09) Burke, George C.; Adams, Carmen AnnA research team conducted a focus group study of central Texas nurses over a period of several weeks during September and October of 2009, at four different long-term care facilities. The total number of respondents was 15. We sought insight into the experience of nurses in quality of care, the nurses' perceptions of management competence, and we sought the nurses' perceptions of their roles as contrasted with the roles of certified nursing assistants (CNAs). Basing our set of questions on those from a 2001 study of CNAs, we found that nurses view quality in a holistic manner - - meeting the physical, emotional and spiritual needs of the resident to the greatest degree possible. We found that nurses in one of the four facilities had made progress in cultural change. Nurses and families saw management competence as the effectiveness and speed in which managers responded to questions or complaints. The study found nurses to be motivated by the job itself, seeing it as a ministry to the elderly. Several managerial implications are included in the study, including management's role in quality, motivation, and cultural change.Item A Practitioner's Guide to Culturally Sensitive Practice for Death and Dying(2002-04) Cohoe, Merri; Contreras, Sue Ellen; Sparks, DebraThe purpose of this manual is to educate health care professionals in all areas of practice regarding religious and cultural beliefs in reference to end of life issues. This information is imperative to the helping process, and when utilized, will allow practitioners to provide the best possible service to clients. The following information is to be used as a general guideline and should not be considered definitive with respect to an individual's personal, religious, or cultural beliefs and perceptions. This manual is a collaboration of materials collected with the purpose of assisting practitioners in facilitating culturally and religiously sensitive service at this extremely fragile time in the helping process. In many circumstances, a lack of awareness or information deters professional engagement in times of grief and loss. This disengagement may be misconstrued as a lack of compassion, when in fact, the practitioner may lack the knowledge and cultural understanding required to serve diverse populations. This resource manual has been designed to enhance the multicultural perspective to include the traditions and beliefs of varied religions, denominations, and institutions concerning death and dying as a valuable component of practice applicable to diverse settings and professions. We encourage health care professions to utilize this tool, and when in doubt, to consult with the client. It is vital to remember that diversity exists not only between religions, but also within.Item A Profile of Nursing Assistants Employed in Central Texas Nursing Homes(1994-12) Ransom, Sandy; Fox, NancyNo abstract prepared.Item Adaptive Music/Dance Therapy: An Activity to Improve Quality of Life in Long Term Care Settings(2010-05) Nauert, RickAs a result of medical advances and improved self-care, people are living longer. By 2050 government forecasts call for 86.7 million individuals aged 65 or older -- encompassing 20.6 percent of the total population. For many, advanced age is accompanied by reduction in mental capabilities and ambulatory capabilities necessitating a need for medical care and/or assistance to perform everyday activities. For the older, old (> 85 years), one of the fastest growing population segments, this often means living in an assisted living or long-term care facility. Although sadness and depression are not a normal characteristic of aging, nursing home residents are often depressed as a host of risk factors accompany aging and residency in a long-term care facility. Interventions to provide mental stimulation, overcome loneliness, foster social support, aid functional capabilities, and improve perception of care are needed for this special population cohort. In an effort to address these issues we initiated a pilot study of an intervention that blended active music therapy and modified danced therapy. Twenty-two residents from two senior facilities (19 skilled residents and 3 from an Assisted Living setting) were assessed. All skilled residents were wheel chair bound while assisted living residents were ambulatory. Three residents dropped from the study. Twice a week, 45-60 minute activity sessions were performed for 8 weeks. Pre-and post-study assessment of cognitive status, depression symptoms, and functional abilities were performed. Regression analysis discovered mild improvements in mental status and cognitive abilities and a significant improvement in depression scores (p = .000).Item An Analysis of a Statewide Survey and the Assessment of Needs within the Long Term Care Delivery System in the State of Texas(1995-09) Upchurch, Marian; Knox, BethThis needs assessment study addressed the needs of various components of the nursing home industry in Texas - those involved in management of long term care facilities, those involved in direct care of long tern care residents, owners of long term care facilities, those involved in regulatory aspects of long term care, and those involved consumers - direct and indirect - of services in long term care facilities. The assessment addressed structural, process, and educational needs of nursing homes. Ten key items were identified via several pretests and utilized in the final survey through a closed format Lilcert-type instrument and a narrative component which also allowed for an open-ended expression of ideas or concerns. The ten key items utilized in the final survey were: (1) Management training for all supervisors, (2) More geriatric nursing skills, (3) Increased physician involvement, (4) Greater consistency in the survey process, (5) Requirement for improved nurse aide to resident ratio, (6) More sensitivity by staff to resident needs, (7) Improvement in food quality and the dining environment, (8) Greater family involvement, (9) More homelike environment, and (10) More educational requirements in long term care for initial licensure as a nursing home administrator. Subjects were asked to rank these ten key items as well as to indicate how much should be done to address each item. In addition to the ten items included in the instrument, subjects were also given an opportunity to identify one additional specific concern in long term care. These comments were assembled and presented in the final report. Respondents gave an overall rating to the quality of care in nursing homes at 5.37 on a ten point scale. Consumers ranked care with a low of 2.6, while administrators recorded the highest rating of 6.8. The highest priority ranked item by the survey respondents was more sensitivity by staff to resident needs. The highest priority items were also grouped as structural, process, and educational needs, and analyzed with the following results. The structural item ranked highest in importance by the survey group was the requirement for improved nurse aide to resident ratio. The highest priority ranked process item was more sensitivity by staff to resident needs. Two educational needs emerged with highest priority rankings: the highest ranked was that of more geriatric nursing skills. Management training for all supervisors was ranked slightly lower. When the importance of the ranking of the ten items was contrasted with the desire to take action on each of the ten items, these same items appeared as the major four items to be addressed. The results varied when the rankings of the ten key items were analyzed by region of Texas or by position of the respondent. Consumers, regulators, and directors of nurses agreed that the highest priority of concern was the requirement for improved nurse aide to resident ratio. Owners and administrators believed the highest priority issue to be greater consistency in the survey process. An analysis of the highest ranked issues by region of Texas indicated that the east and west regions agreed that the highest ranked item was more geriatric nursing skills; central and south regions of Texas rated more sensitivity by staff to resident needs at the top rank; and the metropolitan areas of Texas indicated the requirement for improved nurse aide to resident ratio as the highest ranked item.Item Culture Change in Long-term Care: Its History and Development, Principles, Implementation and Legislation(2011-09) Seaton, David; Edwards, ChristinaCulture change is the common term used to describe the transformational change many long-term care facilities are beginning to embrace. In this transformation, services provided for elders and individuals with disabilities become person-centered, and the voices of residents and those serving them are considered and respected. The core values of culture change are choice, dignity, respect, self-determination and purposeful living. This monograph describes the history and principles of culture change. It describes the leading organizations in culture change, and discusses the benefits of culture change adoption for a long-term care facility's operations, satisfaction rates, and financial outcomes.Item Culture Change in Texas: A Survey of Practices, Implementation and Legislation in Long-Term Care(2011-09) Seaton, David; Edwards, ChristinaCulture change refers to the national movement that calls for the transformation of long-term care services for elders and individuals with disabilities. Culture change considers and respects the person-centered values of the individual receiving care and the people who provide care to the individual. In Texas, culture change has reached to nursing homes for elders, long-term care settings for individuals with disabilities, and has affected legislation concerning state supported living centers. This monograph discusses culture change adoption in Texas, organizations that support culture change, and legislation involving culture change and Texas' State Supported Living Centers for individuals with disabilities.Item Eden Alternative: The Texas Project(2000-05) Ransom, SandyLoneliness, helplessness, and boredom dominate the lives of many nursing home residents. Even though many regulations and programs are in place that are intended to assure quality of care, the confines of the nursing home environment and the widespread entrenchment of the "medical model" do not necessarily contribute to quality of life. Even the most modern and beautifully designed nursing homes sometimes seem to be pervaded with sterile overtones and lack the true warmth of a home. The Eden Alternative, a conceptual model developed by William H. Thomas, M.D., places the residents at the center of nursing home life. The nursing home is transformed into a "human habitat", an environment of diversity. Animals, plants and gardens, children and people of all ages form an integral, daily part of resident life. Residents regain a sense of worth as they care for the plants and animals and they share daily activities with the children as well as with each other. The management style is converted from a hierarchical model to a prototype in which decisions are moved closer to the residents. Staff members are empowered to form self-directed work teams and to take responsibility for managing their own work schedules. The Texas Eden Alternative project replicated Dr. Thomas' model in a different geographical location with a larger sample size. A multidisciplinary task force developed new instruments, recruited individuals willing to develop the Eden Alternative in their communities, and collected data. Resident and staff variables, which are known to influence the satisfaction and quality of life, were carefully gathered over a two-year time period. Although not all of Dr. Thomas' findings were validated in the Texas study, other outcomes showed promising trends. Both cumulative findings and results at specific individual homes have implications for continued research and future policy decisions.Item Education in Gerontology in Texas Schools of Social Work(1996-02) Murray, YvetteWill the supply of social workers trained in gerontology meet the increasing demand for social services from the elderly population? The research study evaluates the present situation concerning formal education in gerontology in Texas schools of social work. Questionnaires were mailed to all accredited undergraduate and graduate programs, plus three new, nonaccredited graduate programs. Follow up telephone calls produced a 100% response rate from the research population. The results of the survey indicated that the majority of undergraduate programs use field settings involving the elderly, but less than half of these programs offer specific courses in aging. All accredited graduate programs have courses and field practicums in aging; however, only one program offers a specialization for advanced study in gerontology. None of the new graduate programs have courses or specializations in aging. When social work students do enter field internships in agencies which serve the elderly, they generally do not receive stipends. Of the of 25 undergraduate and seven graduate programs surveyed, only one social work program had more than one stipend available annually.Item Evaluation of Aromatherapy in Institutional Elder Care Settings(2008-09) Ransom, Sandy; Adams, Carmen AnnThe purpose for conducting this study was to assess the effects of aromatherapy administered by patch application to people living in several Texas nursing homes. Specifically formulated blends of essential oils were evaluated regarding effects on people who inhaled the oils. Three different oil blends were tested. A total of 39 people participated in the study with a mean age of 79.8 A majority (72%) of the participants carried a diagnosis of Alzheimer's disease, dementia, or a mental health disorder. Evaluation conducted before and after introduction of one of the blends, a combination of grapefruit and frankincense essential oils, demonstrated significant differences in specific behavioral characteristics exhibited by 13 persons suffering from dementia. Two people were able to stop taking psychotropic medications. One individual was no longer required to live on a locked unit. Additional oil blends, one containing rosemary and orange oils and another comprised of lavender and bergamot oils, yielded statistically insignificant results. However, strong anecdotal evidence was submitted from persons in a small rural home testing the rosemary/orange oil blend. Potential areas impacted through these findings include an increase in the quality of life for the Elders, a more welcoming and reassuring atmosphere for staff members and visitors, a reduction in costs associated with medications, and decreased time and effort dealing with disruptive behavioral issues. All of these issues are dealt with daily in nursing homes throughout the county.Item Evaluation of the Effectiveness of a Computer Based Communication System in Enahncing the Communicative Abilities of Individuals with Severe Aphasia(1997-06) Koul, RajinderOne of the most significant recent advances in improving the communicative abilities of individuals with chronic severe aphasia has been the development of augmentative and alternative communication (MC) methods; that is techniques, strategies, and symbols for augmenting or replacing natural speech. The major aim of this proposal was to implement and evaluate the effectiveness of a computer-based MC communication system in nonspeaking individuals with aphasia. Eight individuals with severe chronic aphasia received extensive training on a special software program that turns a microcomputer into an electronic communication device. This software program is designed to offer representational graphic/pictorial symbols in conjunction with synthetic voice output to nonspeaking individuals. During the first phase of the training, participants were trained in two primary tasks: first, accessing the software program and identifying and manipulating the symbols/vocabulary items from different grammatical categories; second, constructing sentences using simple subject-verb-object syntax. Phase II involved providing each participant with a communication book which contained symbols specific to each individual subject. The caregivers and the subjects were trained on the efficient and effective use of the book. Overall, the results of this study reveal that individuals with severe aphasia are capable of learning the mechanics of a computer to access, manipulate, and combine graphic symbols to produce simple sentences. The finding that individuals with aphasia can learn computer-based graphic symbols has significant clinical and public policy implications.Item Faith in Action: A Mutual Adoption Pact(2000-05) Renick, Oren; Dolezal, Carl; Marlow, Tim; Barber, StaceyThe youth of today are being denied an opportunity to learn through service. Service can provide youth with a sense of direction and accomplishment. These foundations lead to confidence and compassion during the often tumultuous years of young adulthood. College and high school student organizations are ideal sites to teach service-excellence to tomorrow's leaders. The Southwest Texas State University's Student Chapter of the American College of Healthcare Executives (ACHE) is such an organization. The Mutual Adoption Pact (MAP) is an intergenerational service-mentoring program between youth and senior adults. The ultimate goal of MAP is to build enduring relationships that are mutually beneficial to those who give and receive care. Through this goal, those involved can gain a profound understanding of leadership, caring and service. Program description, development, and results are detailed for possible replication by other communities.Item Item Impact of the Eden Alternative™ on Texas Nursing Homes Residents' Quality of Life: A Psychosocial Perspective(2001-01) Wylie, RichWhat effect does the Eden Alternative™ have on the quality of life of nursing home residents? Recent studies on this innovative approach to changing nursing home culture have yielded promising results using medical and administrative indicators. However, these studies have limited outcomes on psychosocial issues that influence the quality of life for nursing home residents. The purpose of this study was to address this limitation by conducting a more in-depth evaluation of the effectiveness of the Eden Alternative™ on nursing home residents' quality of life using scientifically proven reliable and valid psychosocial instruments; the Life Satisfaction Index (LSI) and the Sheltered Care Environment Scale (SCES) were chosen to measure the psychosocial variables. The evaluative research consisted of a two-year longitudinal study using a comparison pretest-posttest design. Three Texas nursing homes that initiated the Eden Alternative™ process ,were compared with two Texas nursing homes that did not initiate any aspect of the Eden Alternative™ model. The administration of questionnaires to residents, families, and staff were the primary means of data collection. Results brought to light two major issues that impacted the quantitative and qualitative outcome data. First, certain challenges surfaced during implementation of the Eden Alternative™ process. Secondly, clinical significance was not supported by the data. A discussion of these issues as well as recommendations for future research is provided.Item Prevention, Treatment, and Containment of Methicillin-Resistant Staphylococcus Aureus Infections in County Jails(Texas Department of State Health Services, 2006-09) Betz, Tom; Bowers, Steve; Cavanaugh, John Henry; Espinoza, Rita; Felkner, Marilyn; Hernandez, Dora; Kelley, Mike; Markham, Jeff; McElroy, Nadine; Newsome, Sky; Rohde, Rodney E.; Seale, Mike; Story, Susan; Summers, MikeNo abstract prepared.Item Prevention, Treatment, and Containment of Staphylococcal Infections in Communities(Texas Department of State Health Services, 2007-10) Atteberry, Heather; Baldwin, Tamara; Betz, Tom; Campbell, Jill; Carranco, Emilio, Jr.; Darling, Kathleen T.; Espinoza, Rita; Felkner, Marilyn; Glowicz, JanetMost people have heard terms like "staph infection," "antibiotic resistant bacteria," and "MRSA" (pronounced mersa). This manual is designed to help people understand those terms and to provide guidance in preventing infection and the pain, loss of productivity, and expenses associated with it. This information is intended to inform those who are not necessarily healthcare workers but who have responsibilities related to protecting the health of others -- people with responsibilities in care giving, administration, human resources, education, environmental sanitation, and finance. The guidance is appropriate for the community at large--schools, childcare settings, retirement homes, athletic facilities, businesses, and the home. In this manual we will use the term facility to encompass all community entities with the exception of correctional facilities and health-care facilities. Guidance for correctional facilities and health-care facilities is provided in other documents.Item Privacy in Licensed Texas Long-Term Care Facilities(1999-05) Bennett, Jo-AllisonThe purpose of this research study was to discover how licensed Texas' long-term care facilities are currently addressing the issue of privacy. To achieve this objective, a survey was mailed to all of the 1,162 licensed Texas' LTC facilities (LTC facilities). The response rate was 37%. The profile which emerged from the data revealed that: (1) more responses came from "For Profit" LTC facilities than "Not for Profit" LTC facilities; (2) the mean number of residents per LTC facility is currently 106; (3) the majority of respondents considered privacy to be "very important" because residents have expressed a desire for privacy and respondents believe that privacy would improve residents' quality of life; (4) the mean percentage of residents, per LTC facility, who would/could use a private time room is currently 39.7%; (5) the majority of LTC facilities have provided staff with an inservice that addressed the issue of privacy within the past twelve months; (6) currently, the main obstacle to providing residents with opportunities for privacy is monetary in nature; and (7) currently, the two most common ways of offering residents privacy are "private rooms" and "outside sitting areas".Item Quality Long Term Care: The Role of the Volunteer Ombudsman Part 1: Survey(2000-05) Ostwald, Sharon K; Lees, Emily; Runge, AnkeThe Long-Term Care Ombudsman Program is a federally mandated program to improve the quality of care received by residents of nursing homes throughout the United States. Certified volunteer ombudsman are specially trained to act as advocates and to help identify and solve problems on behalf of residents in long-term care facilitates. Texas relies heavily on volunteers to carry out this important role; the approximate ratio of paid staff to volunteers is 1:21. The primary aims of this survey of certified volunteer ombudsman in Texas were to (a) gain a better understanding of their experiences; (b) identify barriers to effective job performance; and (c) identify training needs and ongoing needs for education and support. Survey questionnaires were mailed to the 642 certified volunteer ombudsman in 28 regions in the state of Texas. Completed questionnaires were received from 361 volunteers for a return rate of 56%. Certified volunteer ombudsmen are predominantly women (73.6%) with an average age of 65 years. The majority of volunteers are retired and many have had previous experience in the health and social service fields. Many certified volunteer ombudsmen persist in the role for many years; in this study over 60 percent had been ombudsmen for three years or longer. In general, certified volunteer ombudsmen felt that they were most effective in performing tasks directly related to individual residents and in protecting the residents' rights. The certified volunteer ombudsmen felt least effective in resolving system-wide complaints and in influencing broader policy-related activities, such as promoting regulatory and legislative changes. Overall, certified volunteer ombudsmen were satisfied with their role and with their training program. Satisfaction was, however, related to age, education, and length of time as an ombudsman. Younger, better-educated volunteers, and especially those with professional nursing and social work experience, who had been in the ombudsman role for a shorter length of time were less satisfied with the role and with the training, than the older volunteers without professional experience in health care. Volunteers who had left the program were not surveyed. Training for certified volunteer ombudsmen occurs at the local level and is based on a curriculum developed by the State Ombudsman's Office. In general, certified volunteer ombudsmen were satisfied with the curriculum. However, many preferred a centralized training program in Austin to the current localized approach. Certified volunteer ombudsmen identified lack of a clear line of authority and lack of power as the two greatest barriers to their effectiveness. This report contains 30 recommendations for improvement including legislative changes, training suggestions, communication issues, and recruitment, recognition, reimbursement, and retention of volunteers.Item Quality Long Term Care: The Role of the Volunteer Ombudsman Part 2: Focus Groups(2000-05) Ostwald, Sharon K.; Lees, Emily; Runge, AnkeThe Long-Term Care Ombudsman Program is a federally mandated program to improve the quality of care received by residents of nursing homes throughout the United States. Certified volunteer ombudsmen are specially trained to act as advocates and to help identify and solve problems on behalf of residents in long-term care facilities. Texas relies heavily on volunteers to carry out this important role; the approximate ratio of paid staff to volunteers is 1 :21. The primary aims of this study of certified volunteer ombudsmen in Texas were to (a) gain a better understanding of certified volunteer ombudsmen's experiences; (b) identify barriers to effective job performance; and (c) identify training needs and ongoing needs for education and support. In this qualitative part of the study (Part II), eight focus groups, totaling fifty-one certified volunteer ombudsman participants, were held in various geographic locations throughout the state. Groups were similar in their perception of the program and their role as certified volunteer ombudsmen. Experiences in respective facilities varied, however, and the attitudes of the long-term care facility administrators were a major cause of this variance. The regional staff ombudsmen were generally seen as supportive. Overall, the focus group participants appeared to perform their certified volunteer ombudsman duties effectively. They were most successful in addressing problems at the facility level. Focus group participants were generally satisfied with their training, but there was a strong preference for state-level training. The need for more interactive in-service training was expressed strongly by a majority. Many of the barriers to the certified volunteer ombudsmen's effectiveness were factors outside of their control. Within the facilities, they encountered a lack of trained personnel, as well as other problems inherent in institutionalized settings. Lack of power was identified as a major barrier. In addition to recommendations listed in the quantitative part of the study (Part I), the focus groups produced another set of 28 recommendations for improvement. These include suggestions for legislative changes; volunteer training and communication skills; as well as reimbursement, recruitment, recognition and retention of volunteers.Item The Effect of Validation Therapy Training On Satisfaction with Communication and Quality of Relationship Between Staff and Family Caregivers and Demented Residents in Long Term Care(1995-09) Canon, Robert L.The effect of Validation Therapy training on satisfaction with communication and quality of relationship for caregivers of dementia patients was evaluated in a quasi-experimental design. Subjects were recruited from primary family and staff care givers of dementia patients at 5 central Texas long term care facilities. Training was provided by Naomi Feil at her biennial workshops utilizing a multimedia approach with didactic and experiential components. Quality of relationship was measured by the Dementia Caregiver Quality of Relationship Inventory, an instrument developed by the author, while the Interpersonal Communication Satisfaction Inventory (Hecht, 1978) measured care giver satisfaction with dyadic interaction. A test incorporating several instruments developed by Feil (1992) was used to assess validation skills. Demographic and descriptive variables were also collected. Bivariate analysis indicated a significant increase in communication satisfaction for dementia caregivers who received Validation Therapy training when compared to a group of caregivers who received no training. Although there were no differences between family and staff on change in satisfaction level with Validation Therapy training, staff caregivers were significantly more satisfied with communication at both pre-test and post-test. No experimental or caregiver group status effect on quality of relationship was observed. The Validation Therapy skills instrument demonstrated unacceptably low reliability and were excluded from analysis. Discussion of the psychometric properties of these instruments and the need for reliable measures to assess the effect of Validation Therapy training and practice is provided.