Index

A

Abuse and violence

in hospitals, 178-179

in nursing homes, 179-183, 375-377

toward patients, 170, 180-183, 185-186, 375-376, 377

toward staff, 15-16, 170, 177-183, 187-188, 376-377, 512-514

Access to care, 36, 353

in nursing homes, 59, 164, 377-378, 476-477

Acquisitions, 53, 64

Activities of daily living (ADL), 39, 40, 131, 378

Acuity, see Case-mix acuity

Acute care, see Hospitals

Admissions to hospitals, 53, 54, 55, 279-280, 292

Advanced practice nurses (APN), 17, 97-100, 248, 342

barriers to practice, 7, 100, 325, 348, 353

education, 90, 336, 340, 342, 347, 348, 349

see Clinical nurse specialists;

Geriatric and gerontological nursing;

Nurse practitioners

Adverse incidents, 319-320

Age, of nurses, 72-74, 340, 350-351,

see also Elderly population

Agency for Health Care Policy Research (AHCPR), 17, 122, 352

AIDS

in nursing home case mix, 379

special care units, 58, 120

staff attitudes toward patients, 510-512

see HIV transmission

Almshouses, 362

Alzheimer's disease and other dementia, 39, 363-364, 366

special care units (SCU) for, 65, 184-185, 380

staff problems with, 179-180, 184, 389

Ambulatory care, 51, 55-56, 70, 81

American Board of Nursing Specialities, 342, 349

American Indians, 373-374



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--> Index A Abuse and violence in hospitals, 178-179 in nursing homes, 179-183, 375-377 toward patients, 170, 180-183, 185-186, 375-376, 377 toward staff, 15-16, 170, 177-183, 187-188, 376-377, 512-514 Access to care, 36, 353 in nursing homes, 59, 164, 377-378, 476-477 Acquisitions, 53, 64 Activities of daily living (ADL), 39, 40, 131, 378 Acuity, see Case-mix acuity Acute care, see Hospitals Admissions to hospitals, 53, 54, 55, 279-280, 292 Advanced practice nurses (APN), 17, 97-100, 248, 342 barriers to practice, 7, 100, 325, 348, 353 education, 90, 336, 340, 342, 347, 348, 349 see Clinical nurse specialists; Geriatric and gerontological nursing; Nurse practitioners Adverse incidents, 319-320 Age, of nurses, 72-74, 340, 350-351, see also Elderly population Agency for Health Care Policy Research (AHCPR), 17, 122, 352 AIDS in nursing home case mix, 379 special care units, 58, 120 staff attitudes toward patients, 510-512 see HIV transmission Almshouses, 362 Alzheimer's disease and other dementia, 39, 363-364, 366 special care units (SCU) for, 65, 184-185, 380 staff problems with, 179-180, 184, 389 Ambulatory care, 51, 55-56, 70, 81 American Board of Nursing Specialities, 342, 349 American Indians, 373-374

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--> American Nurses Association (ANA), 10-11, 122, 123, 124, 309, 381 Ancillary personnel, see Nurse assistants (NA) and ancillary nursing personnel Antipsychotic drugs, 131, 135, 139, 363, 381 Asian and Pacific Islander population, 34, 35, 374 Assault, 178, 513-514 Assisted living services, 39, 40, 65, 131, 365-366, 368, 378 Assistive lifting devices, 18, 174, 175, 177, 506, 507 Associate degree (AD) programs, 74, 75, 76, 83, 300-301, 302, 335-342 passim, 350 Autonomy and control, 88, 91, 117, 120, 315-316 B Baccalaureate programs, 74-75, 76, 87, 300-301, 302, 334-342 passim, 349, 351 Background checks, 18, 181, 182 Back injuries and pain, 173-175, 505-509 Barriers to practice, 7, 100, 325, 348, 353 Black population, 34, 35, 38 in nursing homes, 78, 373 Blood and body fluids handling, 511-512 Board and care facilities, 63, 364-365 Boren Amendment, 61, 479 Bureau of Health Professions, Division of Nursing, 106, 122 Burnout, 183, 184, 185-186, 347, 388-389, 519-521, 523, 524 C Career development and mobility, 106, 340, 345, 354 Care planning, 96, 316 in nursing homes, 131, 134, 146 Care teams, 1-2, 89, 95, 96, 101, 322-323, 352, 363-364 Case management, 6, 89, 95, 96-97, 321, 434 Case-mix acuity, 261 hospitals, 54-55, 79, 84-85, 93 nursing homes, 58, 129, 131-132, 147, 363, 366, 378-379, 434-435 Case-mix reimbursement, 61-62, 368, 400-401 under Medicaid, 163-165, 479-480, 482-484 Certificate of Need (CON) program, 43, 61, 476 Certification, see Licensing and certification Chronic conditions, 38-39, 40, 58 Clinical nurse specialists, 97-99, 249, 342 Closures, of hospitals, 52, 53 Collaboration, see Care teams Community college programs, 77, 87-88, 335, 340, 350 Community-oriented care, 89-90, 261, 345, 351-352, 354 Competencies in graduate programs, 342, 351-352 of nurse assistants (NA), 17, 70, 102-103 Complication rates, 318-319 Computer skills, 345, 352 Conditions of Participation, 11, 125 Conflict resolution, 183 Continuing education (CE), 342-343, 353, 434 Continuous quality improvement (CQI), 94-95, 104, 384 Continuum of care, 51, 55-58, 66, 96-97, 343 Cost containment and cost reduction, 19, 27-28, 43-44, 343 through cuts in nursing staff, 85-86, 90, 94, 103, 261-262, 347, 409

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--> through hospital restructuring, 1-2, 51, 52, 53, 94 through shifting of care, 55-56, 66 Council on Performance Measurement, 126 Culturally sensitive care, 7, 17, 18, 35-36, 102, 103, 158, 351, 372-373 D Data bases and data management systems, 347, 352 administrative, 112, 145 nursing home assessments, 135-136, 145 patient records, 112-113, 408-409 Dementia, see Alzheimer's disease and other dementia Department of Education, 350 Diagnosis-related groups (DRG), 44, 114, 435 Differentiated practice, 69, 90-91, 337, 340-342, 344-345, 349-350 Diploma programs, 74, 75, 76, 83, 300-301, 302, 334, 335, 336, 350, 433 Directors of nursing, 14-15, 18, 83, 141, 158-159, 348, 391, 397 education, 18, 158-159, 391, 397 Discharge planning, 39-40, 97, 98 Discharges from hospitals, 54, 114-115, 282 Diversity, see Racial and ethnic groups Doctoral degree programs, 335, 336, 337, 338, 339, 341, 342, 348 Downsizing and layoffs, 2, 82, 83, 92, 93, 103, 105-106, 246, 347, 354 E Education and training, 86, 88-91, 256-257, 271-272, 333-354 of advanced practice nurses (APN), 90, 336, 340, 342, 347, 348, 349 for alternative settings, 89-90 in conflict management, 17, 18, 102, 158, 183 continuing (CE), 342-343, 353, 434 differentiated practice, 90-91, 337, 340-342, 349-350 of directors of nursing, 18, 158-159, 391, 397 in interdisciplinary team care, 89, 352 of licensed practical nurses (LPN), 76-77, 303, 335, 338, 432-433 of nurse assistants (NA), 7, 18, 70, 78, 100-101, 102, 157-158, 181 , 391, 432, 468 in occupational safety, 15, 17, 18, 102, 158, 174, 175, 177, 506 of registered nurses (RN), 69, 73-76, 83, 87-88, 300-302, 335, 338 , 339, 350-351, 433 in research skills, 336, 337, 342, 346, 349, 352-353 teaching and faculties, 345, 349, 351 Elderly population, 2, 20, 31, 32-41 abuse of, 180, 374-375 aged 85 and over, 32, 33, 34, 38, 40, 58, 59, 366 health and disability status, 38-39 home health services use, 63 hospital use, 39-40, 54, 282-283, 292 nursing home demand and use, 38, 39, 40, 41, 58, 59, 366, 378-379 see Geriatric and gerontological nursing Emergency rooms, stress and violence in, 178, 184, 513-514 Employment in health occupations, 4, 69, 72, 304-305 registered nurses (RN), 71-72, 93, 304-305 Enrollments in nursing programs, 75, 76, 301, 302, 303 Ethnic groups, see Racial and ethnic groups Evaluation research, 17, 106, 342, 345, 352-353

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--> F Falls, 170, 171 Families, 36-37 role in nursing home care, 131, 165-167, 268, 384-386, 410-411, 413 Fatigue, 169 Fee-for-service (FFS) system, 47, 48, 49 Functional status, 109, 131, 378-379 G Gender, see Men; Women Generic screens, 112-113 Geriatric and gerontological nursing, 321, 350, 379 Graduate degree programs, 335-336, 342, 350, see also Advanced practice nurses (APN) Graduations from nursing programs, 73, 75-76, 301, 302, 303, 337, 350 H Health Care Financing Administration (HCFA), 112, 122 hospital regulation, 125 nursing home regulation, 13, 133, 134-135, 136, 402, 457, 459-460, 462-463 Health maintenance organizations (HMO), 43, 45, 47, 48, 49, 125, 290 Health promotion, 343, 352 Hepatitis transmission, 175, 176, 509 Hispanic population, 34, 35, 38, 374 in nursing homes, 351, 374 HIV transmission, 175, 176, 509, 510 Home health care, 54, 63-64, 70, 365 Home health services, of hospitals, 56, 57, 58, 287 Hospices, 56, 57, 58, 288-289 Hospitals, 22, 51-58, 79-81, 83-85 abuse and violence in, 178-179, 184, 513-514 beds, 54, 55, 79, 284-286, 292 case mix, 54-55, 79, 84-85, 93 closures, 52, 53 continuum of care, 51, 55-58, 96-97 discharge planning, 39-40, 97, 98 home health services offered, 56, 57, 58, 287 hospice services offered, 56, 57, 58, 288-289 injuries among staff, 170, 171, 175, 503 inpatient activity, 1, 53-55, 279-283, 292 licensed practical nurses (LPN) in, 77, 78, 93, 106, 294-297 mergers, 53 nurse assistants (NA) in, 17, 78, 95, 100-103 outpatient care, 55, 56-57, 99, 289, 292 registered nurses (RN) in, 4, 6-7, 44, 45, 79-84, 93, 95, 293-299 regulation of, 11, 102-103, 124-126 restructuring, 1-2, 5-6, 51, 52, 53, 94-106, 113 skilled nursing units, 56, 57-58, 287-288 special care units, 55, 57, 58 staffing levels and mix, 9-12, 44, 45, 68, 70, 79-81, 113, 116-122, 262-263, 294-299 staffing regulations, 11, 125 see Intensive care units (ICU); Quality of hospital care I Income, 38 and Medicaid eligibility, 60, 377-378 Incontinence, 131, 133, 140, 366 Independence, of nursing home residents, 138 Independent practice associations (IPA), 47, 49, 52

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--> Indian Health Service (IHS), 373-374 Informatics, 352 Injuries and illness among staff, 15, 169-172, 246, 248, 503-505 back injuries and pain, 173-175, 505-509 needlesticks, 18, 175-177, 505, 509-512 relation to staffing levels, 15, 173-177, 187 research needs, 18, 175 safety training, 15, 17, 18, 102, 158, 174, 175, 177, 506 Inpatient activity, 1, 53-55, 279-283, 292 impacts on hospital staffing, 79, 84, 93 Instrumental activities of daily living (IADL), 40, 378 Insurance, 46-47, 51, 125 Integrated systems, 51-52, 64, 99 Intensive care units (ICU), 55, 79, 93, 286, 515, 516, 522 J Job satisfaction, 315-316, 323-324, 325, 515-516 among nursing home staff, 159-160 Job security, 86, 92, 345, 354 Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and hospitals, 11, 125-126 subacute care unit standards, 66, 380 K Kerr-Mills Medical Assistance to the Aged Act, 362 L Language skills and barriers, 36, 351, 372-373 Layoffs, see Downsizing and layoffs Legislation, see Nursing Home Reform Act; Omnibus Budget Reconciliation Act (OBRA); Social Security Act; Tax Equity and Fiscal Responsibility Act (TEFRA) Length of hospital stay, 53, 54, 55, 280-281, 282-283, 292 Licensed practical nurses (LPN), 69, 72, 73, 76-78, 80, 304-305 education, 76-77, 303, 335, 338, 432-433 in hospitals, 77, 78, 93, 106, 294-297 injuries among, 172 in nursing homes, 18, 70, 77, 78, 143, 144, 149-154, 158, 430-433 Licensing and certification of advanced practice nurses, 100, 342, 349 of health care providers, 11, 125 of licensed practical nurses (LPN), 69 of nurse assistants, 17, 70, 102, 181-182 of nursing homes, 133, 136, 460 of registered nurses (RN), 69, 71, 337 Life expectancy, 32, 34 Lifting injuries, 15, 18, 171, 174, 175, 177, 505, 507-508 Living arrangements, 36-37 Long-term care, see Assisted living services; Nursing homes M Managed care, 1, 19, 45, 47-49, 52, 96, 261-262, 348 Master's degree programs, 83, 335-336, 337, 338, 339, 341, 351, see also Advanced practice nurses (APN) Medicaid, 23, 38, 46, 51, 60, 61-62, 133, 163-165, 353, 362, 377-378, 463, 475-484 passim case-mix reimbursement, 163-165, 479-480, 482-484

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--> and cost containment for nursing homes, 61-62, 385 income and asset eligibility, 60, 377-378 prospective payment system, 61, 62, 163, 479, 480-481 Medicare, 38, 46, 51, 113, 126, 350, 353 home health service coverage, 57 and nursing homes, 46, 60, 62, 133, 362, 363, 377, 484-485 prospective payment system (PPS), 43-44, 62, 79, 114 Men elderly, 36 in nursing, 72, 345, 351 Mergers and acquisitions, 53, 64 Minimum data set (MDS), 13, 134, 135, 145-146, 383, 415, 460 Minority groups, see Racial and ethnic groups Mortality rates, 109, 112, 114 in nursing homes, 131, 133 relation to staffing ratios, 9, 112, 117-120, 317-318, 348 Multistate Nursing Home Case-mix and Quality Demonstration Project , 147, 402 N National Center for Health Statistics, 106, 122 National Institute of Nursing Research (NINR), 17, 106, 122, 336, 352 National League of Nursing (NLN), 334, 348 Needlestick injuries, 18, 175-177, 505, 509-512 Neonatal intensive care units (NICU), 520-521 Nurse anesthetists, 85, 100 Nurse assistants (NA) and ancillary nursing personnel, 2n, 69-70, 72, 73, 78, 304-305, 347-348 abuse and violence involvement, 16, 18, 180-182, 376, 514 competencies, 17, 70, 102-103 conflict management training, 17, 18, 102, 158 and culturally sensitive care, 17, 18, 102, 103, 158, 372-373 in hospitals, 7, 17, 70, 100-103, 294-297 injuries among, 15, 171, 172, 174, 503-504, 505-506 occupational safety training, 15, 17, 18, 102, 158 training, 7, 18, 70, 78, 100-101, 102, 157-158, 181, 391, 432, 468 wages, 156, 160, 370, 371 Nurse midwives, 85, 100 Nurse practitioners, 85, 97, 99-100, 342, 347, 350 Nursing Home Reform Act, 68, 83 Nursing Home Resident Assessment System, 135, 459-460 Nursing homes, 58-66, 362-366, 426-429, 471-473, 477-479 abuse and violence in, 179-183, 374-377 access issues, 59, 164, 377-378, 476-477 alternative services, 40, 42-43, 64-65, 365-366, 472 bed supply and occupancy, 58-59, 472-476 case mix, 58, 129, 131-132, 147, 363, 366, 378-379, 434-435 complex technologies in, 59, 65 conflict management, 183 cultural issues, 372-374, 411, 413-414 directors of nursing in, 14-15, 18, 141, 158-159, 391, 397 injuries among staff, 170, 171, 173-174, 269, 503 and Medicaid, 23, 46, 60, 61-62, 133, 163-165, 362, 377-378, 463, 475-484 passim and Medicare, 46, 60, 62, 133, 362, 363, 377, 484-485 mergers and acquisitions, 64

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--> nurse assistants (NA) in, 13-14, 18, 70, 78, 143, 144, 149-154, 156-158, 160, 252-253, 263-265, 369, 370-371, 381, 399, 432 ownership, 50, 162, 364, 403, 485-489 profits, 486-487, 488 registered nurse (RN) in, 13-14, 83, 141, 142, 143, 144, 148-154, 160, 161, 199-204, 371, 381, 391, 430-432, 462-463 regulation of, 133-136, 141-142, 367-368, 381-382, 457, 459-461 reimbursement mechanisms, 46, 61-62, 162-165, 270-271, 368, 385, 479-485 restructuring, 64-66 salaries, 160-161, 369, 371-372, 466-467 shift to rehabilitative care, 42-43, 64-65, 134, 367, 379, 412-413 special care units (SCU), 65, 379, 380 staff education and training, 83, 411-412, 432-434 staffing levels and mix, 4-5, 12-13, 18, 68, 129, 141-144, 146-158, 167-168, 190-191, 368-370, 393-399, 429-430, 435-436, 437-450, 461 -465, 468-470 staffing needs and demand factors, 13, 22-23, 59, 83, 381, 434-435 staffing regulation, 141-142, 167-168, 253, 369-370, 381-382, 427, 462-463, 470-471, 491-492 staff turnover, 263, 430 subacute care units, 5, 65-66, 366, 379-380 24-hour registered nurse (RN) presence, 18, 83, 141-142, 153-155, 162, 199-204, 369, 381, 403 see Quality of nursing home care Nursing shortage, 71, 353, 371 educational component, 349 and nursing homes, 141 O Occupational health, see Injuries and illness among staff; Stress Older persons, see Elderly population Ombudsmen, 167, 250n, 394 Omnibus Budget Reconciliation Act (OBRA), 12, 61, 62, 133-134, 168 , 181-182, 364, 367-368, 381, 383, 457, 459 implementation, 140-141 nursing coverage requirements, 12, 141-142, 383-384, 462-463 waviers, 141-142, 369, 381-382, 382 Oncology clinical nurse specialists, 98 Organizational factors, 17, 118, 121, 122, 308-309, 314 Outcome measures, 23-24, 344, 345, 346 hospitals, 108-109, 111, 123-124, 313-315, 325-328 nursing homes, 130, 131, 383, 456 Outpatient care, 55, 56-57, 99, 289, 292 Overexertion, 170, 171, 174 Ownership of facilities, 50, 247 nursing homes, 50, 162, 364, 403, 485-489 P Partners-in-practice models, 101-102, 344 Patient-centered care, 94-95, 101 Patient satisfaction, 322-323, 325 with managed care, 48, 49 with nursing homes, 131 and restructuring, 17, 106 Peer Review Organizations (PRO), 113 Perkins Act programs, 350 Personal care activities of daily living (ADL), 40, 378 Population, growth rate, 32-34, see also Elderly population; Racial and ethnic groups Postdoctoral training, 337, 339 Poverty status, 38

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--> Preferred provider organizations (PPO), 45, 291 Pressure sores and decubitis, 131, 133, 157 Preventive medicine, 343 Primary care, 97, 342, 343, 344 Process of care indicators, 108, 110-111 for nursing homes, 129, 130, 131, 456-457 Professional practice models, 118, 258, 310-311, 313, 315-316, 324 , 405-407 Profit margins, 50 Prospective payment system (PPS), 60 impacts on staffing, 44, 79 under Medicaid, 61, 62, 163, 479, 480-481 under Medicare, 43-44, 62, 79, 114 Psychiatric clinical nurse specialists, 342, 348 Public health nursing, 90 Q Quality assurance and quality improvement (QA/QI), 10-11, 104, 107 in nursing home assessment, 135-136, 460 Quality of hospital care, 28, 113-116, 245-250, 265-267 advanced practice nurses role in, 17, 97-100 and ancillary nursing personnel, 17, 100-103 elements of, 107-109, 110-111 legislation and regulation, 11, 102-103, 124-126 measurement of, 8-9, 106-113, 325-328 and organizational restructuring, 5-6, 94-106, 113 performance indicators and standards, 122-124 prospective payment system impacts, 9, 114-115 research needs, 8, 10-11, 17, 106, 116, 121-122, 127 and staffing level and mix, 9-12, 113, 116-122 Quality of nursing home care, 12, 28, 132-146, 250-256, 267-269, 456-457 elements of, 129-131 families' roles in, 131, 165-167, 268, 384-386, 410-411, 413 and geriatric specialists, 18, 155-156, 381-382, 396-398, 414-415, 467-468 and job satisfaction, 386-387, 399 and job stress, 387-390 legislation and regulation, 133-136, 141-142, 367-368, 381-382, 457 , 459-461 management issues, 18, 158-159, 403-405 measurement of, 129-132, 382-385, 407-409, 454-457 and nurse assistants (NA), 18, 156-158, 399 ombudsmen's role in, 167, 394 outcomes-based incentives, 165, 490-491 and ownership, 162, 403, 487-489 and patient mix, 131-132 and reimbursement mechanisms, 15, 385, 400-403, 412, 490-491 research needs, 18, 407-411 resident assessment tools, 135-136 and staffing levels and mix, 12-13, 18, 146-158, 167-168, 190-191, 393-399, 435-436, 437-450, 468-470 and staff training, 390-392, 467-468 and staff turnover, 159-160, 386-387, 394, 399-400 24-hour registered nurse (RN) presence, 18, 141-142, 153-155, 199-204, 381 volunteers and, 166

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--> R Racial and ethnic groups, 34 elderly population, 32, 34-36, 38, 373-374 in nursing, 249, 345, 351 nursing home residents, 374 nursing home staff, 372-373 see American Indians; Asian and Pacific Islander population; Black population; Culturally sensitive care; Hispanic population; White population Record review, 112-113 Registered nurses (RN), 4, 69, 70, 304-305, 350-351 autonomy and control, 88, 117, 120 differentiated practice, 69, 90-91 education, 69, 73-76, 83, 87-88, 300-302, 335, 338, 339, 350-351, 433 in hospitals, 4, 6-7, 44, 45, 79-84, 93, 95, 293-299 injuries among, 172 in nursing homes, 13-14, 83, 141, 142, 143, 144, 148-154, 160, 161 , 199-204, 371, 381, 391, 430-432, 462-463 salaries, 80, 85-86, 160, 161, 337, 369, 371 shifts in service settings, 81-82 supervisory duties, 13-14, 95, 347 see Advanced practice nurses (APN) Registries, 181-182 Regulation of hospital operations, 11, 102-103, 124-126 of hospital staffing, 11, 125 of nursing home operations, 133-136, 141-142, 367-368, 381-382, 457 , 459-461 of nursing home staffing, 141-142, 167-168, 253, 369-370, 381-382, 427, 462-463, 470-471, 491-492 Rehabilitative care, 42-43, 64-65, 134, 367, 379, 412-413 Rehospitalization rates, 131, 133 Reimbursement mechanisms, 43-44, see also Case-mix reimbursement; Prospective payment system (PPS) Report cards, 122-124 Research needs, 192 for quality of hospital care, 8, 10-11, 17, 106, 116, 121-122, 127 for quality of nursing home care, 18, 407-411 Resident assessment instrument (RAI), 134, 135-136 Resident assessment protocols (RAP), 134, 135 Resident assistants, 157 Residential facilities, 63, 64 Resource constraints, 107, 129 Resource utilization groups (RUGS), 147, 163, 401, 402-403, 434-435 Respect, of nursing home residents, 138 Restraints, 131, 135, 138-139, 381 Restructuring, 19, 343-345, 347-349 monitoring effects of, 17, 105-106 and staffing patterns, 95-97 staff involvement in, 17, 103-105, 265-267, 348 RUGS, see Resource utilization groups (RUGS) S Salaries and compensation nurse assistants (NA), 156, 160, 370, 371 nursing home staff, 160-161, 369, 371-372, 466-467 registered nurses (RN), 80, 85-86, 160, 161, 337, 369, 371 Satisfaction, see Job satisfaction; Patient satisfaction Security measures, 65, 180 Service learning, 346, 348

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--> Service utilization, 320-322 Sharp objects, 176, 509-510 Shift work, 519-520 Sigma Theta Tau, 334 Social Security Act, 125, 133, 141, 362, 457 Special care units (SCU), 55, 57, 58 for AIDS, 58, 120 for Alzheimer's disease, 65, 184-185, 380 in nursing homes, 65, 379, 380 Specialization, 120 State boards of nursing, 7, 100, 257 State-level associations, 122, 247-249 State regulation, of nursing homes, 142 State surveyors, 133, 135, 140, 367-368, 413, 460, 461 Stress, 169, 183-187, 246, 248, 514-521 and turnover, 185-186, 522-524 Structural measures of care, 108, 110, 118 in nursing homes, 129, 130, 383 Subacute care units, 5, 65-66, 366, 379-380 Substitutions of staff, 85-86, 92, 246, 248, 343, 348, 385 Supply of nursing personnel, 4, 69-78, 87-91, 304-305, 342 Support networks, 187, 389-390 T Tax Equity and Fiscal Responsibility Act (TEFRA), 43-44 Team care, 1-2, 89, 95, 96, 101, 322-323, 352, 363-364 Telecommunications, 352 Total quality management, 94-95, 104 Tube feedings, 133, 166 Turning patients in bed, 157 Turnover and retention of directors of nursing, 158 of nursing home staff, 159-160, 263, 386-387, 394, 399-400, 430 relation to stress, 185-186, 522-524 24-hour registered nurse (RN) presence, 18, 83, 141-142, 153-155, 162, 199-204, 369, 381, 403 U Undergraduate programs, see Associate degree (AD) programs; Baccalaureate programs Unemployment in nursing, 72, 73, 78, 105 Unions, 245-248, 251-252 University programs, 340, 345-347, 348-349, 350 Urethral catheterization, 132, 140 V Ventilator care, 57, 59, 65 Violence, see Abuse and violence Volunteers, 166, 191 W Wages, see Salaries and compensation Waivers home- and community-based care, 63 nursing home staff requirements, 14, 141-142, 154, 200, 202-203, 369-370, 381-382 Weapons, 178-179, 513-514 White population, 34 elderly, 34, 35, 38, 373 Women elderly, 36, 38, 375 home health services use, 63 as informal caregivers, 37 in nursing, 72, 156 occupational injuries among, 171, 172 and violence, 178, 375 Workplace hazards, see Injuries and illness among staff; Stress