Brannon D, Mor V, Zinn J, Davis J; Association for Health Services Research. Meeting.
Abstr Book Assoc Health Serv Res Meet. 1998; 15: 116-7.
Pennsylvania State University, University Park, PA 16802, USA.
RESEARCH OBJECTIVE: Recent environmental changes have prompted differentiation and complexity in the delivery of skilled nursing services. While continuing to provide "home-like" continuing care for disabled residents, they also provide a variety of rehabilitation services of a sub-acute nature. Some areas of care, such as prevention of pressure ulcers, are now guided by clinical protocols which reflect known cause/effect relationships. Other care processes, particularly in the mental health arena, are less clearly prescribed. Contingency theory suggests that successful organizations develop structures which fit their production processes, or in this case, care processes. In this paper, we examine the extent to which differentiated structural conditions are associated with alternative care processes, comparing physiological and psychosocial domains of care. STUDY DESIGN: we used a stratified random sample of nursing homes drawn from the universe of Medicare/Medicaid certified facilities in 8 states reported by in the On-Line Survey Certification Automated Record (OSCAR) from mid-1995. The sample was stratified by urban-rural location, ownership status, chain affiliation and size, using sampling for replacements within strata and adjusting for differential non-response by strata. 308 facilities participated in the study and 273 completed both the Director of Nursing (DN) phone interview and the Unit Charge Nurse Questionnaire. Information was obtained from both these sources regarding structuring. The DNs were asked about organizational hierarchy and control mechanisms and the CNs were asked about the structuring of tasks related to care processes in several clinician domains. PRINCIPAL FINDINGS: Preliminary results (n=156) from the CN survey indicate that psychosocial care is structured in a more decentralized, less controlled manner than is physiological care. The mean proportions of facilities which gave their nurse aides "complete freedom" in how to perform tasks related to effecting changes in depressed mood and identifying and managing cognitive changes were 40% and 48.5%, respectively. In contrast, these same means for preventing pressure ulcers and managing pain were 28.4% and 24%, respectively. Descriptive findings from the entire sample and analyses which compare differentiation of task structuring within facilities are currently being generated. From the DN survey, it was reported that nurse aides who attend care planning meetings are expected to contribute information about physiological care and conditions more frequently (99%) than they are expected to contribute to planning psychosocial care (77%). Similarly, nurse aides were less likely (54%) to have a primary or substantial contribution to resident assessments in psychosocial care domains in contrast to physiological domains (92%). CONCLUSIONS: These preliminary findings support the structural contingency argument that form follows function. Mental health care is less easily adapted to the "care routines" which structure physical care in nursing facilities. In the absence of clear practice guidelines, nurse aides are more likely to be afforded considerable discretion in mental health-related task performance and rarely held accountable in terms of contributing to psychosocial aspects of resident assessments of care plans. In the physiological domains of care, where protocols do exist, task behavior is more prescribed and accountability is more frequent. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Given the reliance on non-professional staff in providing long term care services, finding the most productive fit between care processes and structural conditions is particularly salient. Further analyses of these data will examine whether the fit between care processes and structure affects aggregate resident outcomes in the sample of facilities.
Publication Types:
Keywords:
- Data Collection
- Evaluation Studies
- Long-Term Care
- Nurses
- Nurses' Aides
- Nursing Homes
- Ownership
- Questionnaires
- Research Design
- nursing
- hsrmtgs
Other ID:
UI: 102234212
From Meeting Abstracts