JAMDABriefs

Long-Term Care Residents Have Mixed Response to On-Site AEDs 

After attending an information session on automated external defibrillators (AEDs), 83 residents of a continuing care retirement community were surveyed regarding their opinions on having AEDs installed in their facility, as well as their beliefs and concerns regarding AEDs and their own advance directives. The results: 27% of participants indicated that they wanted AEDs installed, 23% were opposed, and 37% weren't sure. The remaining 11% didn't answer. Some expressed the concerns that “AED use might lead to a very poor quality of care” and that “AEDs might be misused.”

Based on the varied responses, the researchers suggest that long-term care staff discuss automated external defibrillators with all residents before installing them.

Source: Do Residents Want Automated External Defibrillators in Their Retirement Home? — Woolley et al.

Comparison of Two Data Sources On Pain Presence and Intensity 

A recent article in the Journal of the American Medical Directors Association outlines a study that compares nursing home residents' reports of pain presence and intensity on an interview questionnaire with the same information on their most recent Minimum Data Set (MDS).

The research found that pain was reported 1.3 to 1.8 times more often on the questionnaire than in the MDS, depending on the respondent group. A group of residents that used family proxies to report pain showed the largest discrepancy for both pain presence and intensity. Researchers suggest that pain information is most accurate when obtained directly from residents, and that pain observations must be standardized.

Source: Measuring Pain Presence and Intensity in Nursing Home Patients — Lin et al.

Family Members of Residents and Long-Term Care Staff Share Stress 

Interviews with family members of long-term care residents and the facilities' staff highlight a failure to settle family complaints about care. Nine family members with persistent complaints about the care of their relatives were interviewed, and two focus groups were held with five nurse managers.

Common areas of complaint include the family members' perception that staff is incompetent, interfamilial conflicts, and unresolved psychosocial issues. Contributing factors to these complaints include staff's vulnerability to challenges of their professional competence, as well as increased time spent educating and supporting staff to cope with distraught families.

Long-term care staff suffer increased stress as a result. However, they need to realize that family members are themselves under stress due to their continuing roles as caregivers to institutionalized loved ones.

Source: Persistent Family Concerns in Long-Term Care Settings: Meaning and Management — Marziali et al.

Organizational Change Used as QI Measure for Reducing Pressure Ulcers 

A 136-bed nursing home in Pennsylvania with a high rate of pressure ulcers introduced a QI intervention for the problem that involved cultural change. All staff participated in the intervention, which resulted in 100% compliance with the new QI measures and a significant reduction in pressure ulcers. Every staff member received education and training on pressure ulcer prevention and early detection, was eligible for cash incentives for reductions in pressure ulcer incidence, and received positive and/or negative real-time management feedback. During the intervention, there was a significant reduction in the emergence of stage 1 through 4 pressure ulcers. But when the rewards and discipline components of the intervention were no longer actively maintained, the incidence of pressure ulcers increased.

Source: Ability, Incentives, and Management Feedback: Organizational Change to Reduce Pressure Ulcers in a Nursing Home —Rosen et al.