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
in nursing homes, 59, 164, 377-378, 476-477
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
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
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
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
Blood and body fluids handling, 511-512
Board and care facilities, 63, 364-365
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
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
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
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
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
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
F
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
Hepatitis transmission, 175, 176, 509
Hispanic population, 34, 35, 38, 374
HIV transmission, 175, 176, 509, 510
Home health care, 54, 63-64, 70, 365
Home health services, of hospitals, 56, 57, 58, 287
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
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
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
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
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
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)
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
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
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
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
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 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
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
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
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
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
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
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
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 nursing homes, 131
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
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
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
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
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
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
R
Racial and ethnic groups, 34
elderly population, 32, 34-36, 38, 373-374
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 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
Service utilization, 320-322
Shift work, 519-520
Sigma Theta Tau, 334
Social Security Act, 125, 133, 141, 362, 457
Special care units (SCU), 55, 57, 58
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
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
University programs, 340, 345-347, 348-349, 350
Urethral catheterization, 132, 140
V
Violence, see Abuse and violence
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
White population, 34
Women
home health services use, 63
as informal caregivers, 37
occupational injuries among, 171, 172
Workplace hazards, see Injuries and illness among staff;
Stress