Outcomes of Nursing Management Practice in Nursing Homes

描述：(申请人提供)尽管穷人受到广泛关注 美国养老院(NHS)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，我们有需要改进的知识， 例如最佳实践指南、全面质量管理和监管。 然而，所有这些努力都没有带来广泛的改善。 在NH中系统化地应用任何知识的问题，直接指向 有效的护理管理实践(NMP)的需要。研究显示 国家管理计划改变了人们相互之间的关系，例如交流， 参与决策，不同个人之间的互动，以及 以关系为导向的领导，在NHS中产生更好的结果。之前 然而，研究几乎没有提供这些做法实际上是如何 工作，使用起来很困难。这项研究将描述和解释 关系模式和Nimp会导致高质量的行为 或质量不佳的结果。这项研究将提供关于如何 NMPS的工作以及它们如何在实践中应用，从而扩展了我们的知识 关于如何有效地使用它们。这项为期4.5年的研究将探索 关系模式和nimp使NHS能够获得高质量的居民 结果。具体目标是，在选定的NHS中：1)描述关系 模式；2)探讨员工与管理者对关系的理解 正在使用的模式和NMP；3)比较关系模式和NMP 高质量和低质量的住宅；以及4)开发一种 关系模式和国家管理计划的模式，以促进更好的结果。八 比较案例研究将分两个阶段进行，形成阶段和 复制。关于关系模式和相关NMP的假设 具有高质量的结果将在形成案例中生成并在 复制案例。复制案例研究加强了 研究结果。用于比较，并确保确认和 可以获得不确定的证据，将使用已知的小组；两个 形成性和复制性案例研究将包括两个高质量案例和两个 低质量的国民健康保险制度。质量是由MDS QI来衡量的，而真正的 居民对生活质量的认知。方法将包括网络 对文件和记录进行分析、观察、访谈和分析。 所获得的见解将为新一代干预措施提供知识 改善NH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.