Outcomes of Nursing Management Practice in Nursing Homes

描述：（由申请人提供）尽管人们普遍关注贫困 美国疗养院的护理质量和许多改善的努力， 严重的问题依然存在。有趣的是，我们有知识需要改进， 例如最佳实践指南、全面质量管理和监管。 然而，这些努力都没有带来广泛的改善。 在适应任何知识的问题，在一个系统的方式在一个NH，点直接 有效的护理管理实践（NMPs）。研究表明 那些改变人们相互联系方式的NMP，比如沟通， 参与决策，不同个体之间的互动，以及 关系导向的领导，导致更好的结果在NHs。之前 然而，研究并没有深入了解这些做法实际上是如何实现的。 工作，使用困难。本研究将描述和解释如何 关系模式和NIMPs导致高质量的行为 或低质量的结果。这项研究将提供新的理解， NMP的工作原理以及如何在实践中应用，从而扩展我们的知识 如何有效地使用它们。这项为期4.5年的研究将探索 使NHS能够获得高质量住院医师的关系模式和NIMP 结果。具体目标是，在选定的NH中：1）描述关系 探讨员工和管理者对关系的理解 模式和使用中的NMP; 3）比较关系模式和NMP之间 高质量和低质量的居民结果的家园;和4）制定一个 关系模式和促进更好成果的国家管理计划的模式。八 比较案例研究将分两个阶段进行，即形成阶段和 复制的关于关系模式和相关NMP的假设 将在形成性案例中产生高质量的成果， 复制案例复制案例研究加强了 研究结果。为了进行比较，并确保确认和 可以获得不证实的证据，将使用已知组; 形成和复制案例研究将包括两个高质量和两个 低质量的NHS。质量由MDS QIs和真实的衡量标准来衡量。 居民对生活质量的看法。方法包括网络 分析、观察、访谈和分析文件和记录。 获得的见解将为新一代干预措施提供知识， 改善护理。

DESCRIPTION: (provided by applicant) Despite widespread concern about poor quality of care in US nursing homes (NHs) and numerous efforts to improve, serious problems persist. Interestingly, we have knowledge needed to improve, such as best practice guidelines, total quality management, and regulation. However, none of these efforts have yet led to broad-based improvement. Problems in adapting any knowledge in a systemized way in a NH, points directly to the need for effective nursing management practices (NMPs). Research shows that NMPs that change how people relate to one another, such as communication, participation in decision making, interactions among diverse individuals, and relationship-oriented leadership, result in better outcomes in NHs. Prior research, however, provides little insight into how these practices actually work, making use difficult. This study will describe and explain how relationship patterns and NIMPs lead to behaviors that result in high quality or poor quality outcomes. This study will provide new understanding about how NMPs work and how they are applied in practice, thus extending our knowledge about how to use them effectively. This 4.5 year study will explore relationship patterns and NIMPs that enable NHs to attain high quality resident outcomes. Specific aims are to, in selected NHs: 1) describe relationship patterns; 2) explore staffs and managers' understanding of relationship patterns and NMPs in use; 3) compare relationship patterns and NMPs between homes with high-quality and poor-quality resident outcomes; and 4) develop a model of the relationship patterns and NMPs that foster better outcomes. Eight comparative case studies will be conducted in two phases, formative and replication. Hypotheses about the relationship patterns and NMPs associated with quality outcomes will be generated in the formative cases and tested in the replication cases. The replication case studies strengthen the validity of the study results. For comparisons and to assure that both confirming and disconfirming evidence can be obtained, known-groups will be used; both the formative and replication case studies will include two high quality and two low quality NHs. Quality is measured by MDS QIs and the REAL measure of residents' perceptions of quality of life. Methods will include network analysis, observation, interviews, and analysis of documents and records. Insights gained will provide knowledge for a new generation of interventions to improve NH care.