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Halifax E, Harrington C. Proposed Minimum Nurse Staffing Levels in Nursing Homes. Policy Polit Nurs Pract 2024; 25:67-69. [PMID: 38587362 DOI: 10.1177/15271544241237653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Affiliation(s)
- Elizabeth Halifax
- Department of Social & Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Charlene Harrington
- Department of Social & Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
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Halifax E, Harrington C. Nursing home financial transparency and accountability are needed to assure minimum staffing levels. J Am Geriatr Soc 2023; 71:1002-1005. [PMID: 35726127 DOI: 10.1111/jgs.17931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/30/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Elizabeth Halifax
- Department of Social & Behavioral Sciences, University of California, San Francisco, California, USA
| | - Charlene Harrington
- Department of Social & Behavioral Sciences, University of California, San Francisco, California, USA
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Stephens CE, Allison TA, Flint LA, David D, Wertz V, Halifax E, Barrientos P, Ritchie CS. Assessing Technical Feasibility and Acceptability of Telehealth Palliative Care in Nursing Homes. Palliat Med Rep 2022; 3:181-185. [PMID: 36059909 PMCID: PMC9438441 DOI: 10.1089/pmr.2022.0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background Over two-thirds of nursing home (NH) residents are eligible for palliative care (PC), yet few receive it, particularly outside of hospice. Little is known about the technical feasibility and acceptability of using telehealth for PC consultations in NHs. Objective To determine the technical feasibility and acceptability of PC telehealth for NH residents seen by a PC team in the hospital in the previous 30 days. Design Mixed methods study including data collection from field observations, focus groups about the telehealth experience with content analysis, and a web-based survey about technical feasibility and acceptability. Sample and Approach Eighteen participants (six PC-eligible NH residents, one PC physician, five family members, six NH nurses) were recruited in 2016 to participate in one of six PC video visits followed by a video-based focus group and web-based survey. Results All participants were comfortable with the PC video visit format, believed it could improve communication and care coordination, and reported they could see themselves using telehealth in the near future. For technical feasibility, audio quality was rated mostly good/very good (71%) and visual quality was rated fair (50%). Conclusions PC video visits are technically feasible and acceptable to NH residents, families, and staff, representing an innovative and relatively low-cost opportunity to improve access to needed NH-based PC services. Assessing stakeholder perspectives on the use of this technology can help inform the selection of the proper telehealth platform to meet the clinical and infrastructure needs, as well as protocol modifications required before testing in a larger trial.
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Affiliation(s)
- Caroline E. Stephens
- Division of Health Systems and Community Based Care, University of Utah College of Nursing, Salt Lake City, Utah, USA
| | - Theresa A. Allison
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA
| | - Lynn A. Flint
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA
| | - Daniel David
- NYU Rory Meyers College of Nursing, New York City, New York, USA
| | - Victoria Wertz
- Infusion Treatment Area, Stanford Health Care, Stanford, California, USA
| | - Elizabeth Halifax
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Pamela Barrientos
- Division of Health Systems and Community Based Care, University of Utah College of Nursing, Salt Lake City, Utah, USA
| | - Christine S. Ritchie
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA
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Harrington C, Ross L, Chapman S, Halifax E, Spurlock B, Bakerjian D. Nurse Staffing and Coronavirus Infections in California Nursing Homes. Policy Polit Nurs Pract 2020; 21:174-186. [PMID: 32635838 DOI: 10.1177/1527154420938707] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In the United States, 1.4 million nursing home residents have been severely impacted by the COVID-19 pandemic with at least 25,923 resident and 449 staff deaths reported from the virus by June 1, 2020. The majority of residents have chronic illnesses and conditions and are vulnerable to infections and many share rooms and have congregate meals. There was evidence of inadequate registered nurse (RN) staffing levels and infection control procedures in many nursing homes prior to the outbreak of the virus. The aim of this study was to examine the relationship of nurse staffing in California nursing homes and compare homes with and without COVID-19 residents. Study data were from both the California and Los Angeles Departments of Public Health and as well as news organizations on nursing homes reporting COVID-19 infections between March and May 4, 2020. Results indicate that nursing homes with total RN staffing levels under the recommended minimum standard (0.75 hours per resident day) had a two times greater probability of having COVID-19 resident infections. Nursing homes with lower Medicare five-star ratings on total nurse and RN staffing levels (adjusted for acuity), higher total health deficiencies, and more beds had a higher probability of having COVID-19 residents. Nursing homes with low RN and total staffing levels appear to leave residents vulnerable to COVID-19 infections. Establishing minimum staffing standards at the federal and state levels could prevent this in the future.
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Affiliation(s)
- Charlene Harrington
- Department of Social & Behavioral Sciences, University of California, San Francisco
| | - Leslie Ross
- Department of Social & Behavioral Sciences, University of California, San Francisco
| | - Susan Chapman
- Department of Social & Behavioral Sciences, University of California, San Francisco
| | - Elizabeth Halifax
- Department of Social & Behavioral Sciences, University of California, San Francisco
| | - Bruce Spurlock
- Department of Social & Behavioral Sciences, University of California, San Francisco
| | - Debra Bakerjian
- Department of Social & Behavioral Sciences, University of California, San Francisco
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Harrington C, Dellefield ME, Halifax E, Fleming ML, Bakerjian D. Appropriate Nurse Staffing Levels for U.S. Nursing Homes. Health Serv Insights 2020; 13:1178632920934785. [PMID: 32655278 PMCID: PMC7328494 DOI: 10.1177/1178632920934785] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/22/2020] [Indexed: 11/17/2022] Open
Abstract
US nursing homes are required to have sufficient nursing staff with the
appropriate competencies to assure resident safety and attain or maintain the
highest practicable level of physical, mental, and psychosocial well-being of
each resident. Minimum nurse staffing levels have been identified in research
studies and recommended by experts. Beyond the minimum levels, nursing homes
must take into account the resident acuity to assure they have adequate staffing
levels to meet the needs of residents. This paper presents a guide for
determining whether a nursing home has adequate and appropriate nurse staffing.
We propose five basic steps to: (1) determine the collective resident acuity and
care needs, (2) determine the actual nurse staffing levels, (3) identify
appropriate nurse staffing levels to meet residents care needs, (4) examine
evidence regarding the adequacy of staffing, and (5) identify gaps between the
actual staffing and the appropriate nursing staffing levels based on resident
acuity. Data sources and specific methodologies are analyzed, compared, and
recommended. The goal is to assist nursing home nurses and administrators to
ensure adequate nursing home staffing levels that protect resident health,
safety, and well-being.
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Affiliation(s)
- Charlene Harrington
- Department of Social & Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Mary Ellen Dellefield
- Department of Nursing & Patient Care Services, VA San Diego Healthcare System, San Diego, CA, USA
| | - Elizabeth Halifax
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Mary Louise Fleming
- Healthcare Administration and Interprofessional Leadership Program, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Debra Bakerjian
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, USA
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Stephens CE, Halifax E, David D, Bui N, Lee SJ, Shim J, Ritchie CS. "They Don't Trust Us": The Influence of Perceptions of Inadequate Nursing Home Care on Emergency Department Transfers and the Potential Role for Telehealth. Clin Nurs Res 2020; 29:157-168. [PMID: 31007055 PMCID: PMC10242499 DOI: 10.1177/1054773819835015] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
In this descriptive, qualitative study, we conducted eight focus groups with diverse informal and formal caregivers to explore their experiences/challenges with nursing home (NH) to emergency department (ED) transfers and whether telehealth might be able to mitigate some of those concerns. Interviews were transcribed and analyzed using a grounded theory approach. Transfers were commonly viewed as being influenced by a perceived lack of trust in NH care/capabilities and driven by four main factors: questioning the quality of NH nurses' assessments, perceptions that physicians were absent from the NH, misunderstandings of the capabilities of NHs and EDs, and perceptions that responses to medical needs were inadequate. Participants believed technology could provide "the power of the visual" permitting virtual assessment for the off-site physician, validation of nursing assessment, "real time" assurance to residents and families, better goals of care discussions with multiple parties in different locations, and family ability to say goodbye.
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Affiliation(s)
- Caroline E. Stephens
- Department of Community Health Systems, University of California, San Francisco, CA, USA
| | - Elizabeth Halifax
- Department of Physiological Nursing, University of California, San Francisco, CA, USA
| | - Daniel David
- Department of Community Health Systems, University of California, San Francisco, CA, USA
| | - Nhat Bui
- Asian Health Services, Oakland, CA, USA
| | - Sei J. Lee
- Division of Geriatrics, University of California, San Francisco, CA, USA
- San Francisco VA Healthcare System, San Francisco, CA, USA
| | - Janet Shim
- Department of Social and Behavioral Sciences, University of California, San Francisco, CA, USA
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Abstract
BACKGROUND AND OBJECTIVES Transitioning to a nursing home (NH) is a major life event for 1.4 million NH residents in the United States. Most post-acute NH admissions plan for rehabilitation and discharge home, but with nearly 70% of NH residents being palliative care (PC) eligible, many evolve into long-term placements secondary to poor health and associated decline in function and/or cognition. This article describes the perceptions of NH PC-eligible residents and families transitioning to life in a NH. METHODS Residents at 3 NHs in Northern California (N = 228) were screened for PC eligibility. A convenience sample of PC-eligible residents and their family members (n = 28) participated in qualitative interviews that explored the experience of living as a NH resident with serious illness. Data were analyzed using grounded theory methodology. RESULTS Our study provides insights into the experiences of transitioning to a NH from the perspectives of PC-eligible residents and their families. These data describe how PC-eligible residents and their families experienced disempowerment as they perceived being left out of decisions to go to a NH, loss of autonomy once at the NH, dealt with the realization that they would not be going home, and described perceived barriers to going home. DISCUSSION AND IMPLICATIONS The inclusive and person-centered model of care that PC provides naturally empowers residents and family members. Adequate provision of PC services, together with changes in policy related to NH culture and benefit management, could improve the experience of transitioning to a nursing home.
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Affiliation(s)
- Elizabeth Halifax
- Department of Physiological Nursing, 8785University of California, San Francisco, CA, USA
| | | | - Lauren J Hunt
- Department of Physiological Nursing, 8785University of California, San Francisco, CA, USA.,San Francisco VA Medical Center, San Francisco, CA, USA
| | - Caroline E Stephens
- Department of Community Health Systems Nursing, 8785University of California, San Francisco, CA, USA
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Bui N, Halifax E, Uy E, Hunt L, David D, Lee SJ, Ritchie C, Stephens C. UNDERSTANDING NURSING HOME STAFF ATTITUDES TOWARDS DEATH AND DYING. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Bui
- Asian Health Services, Oakland, California, United States
| | - E Halifax
- UCSF School of Nursing, San Francisco, CA, USA
| | - E Uy
- UCSF School of Nursing San Francisco, CA, USA
| | - L Hunt
- San Francisco VA Medical Center, San Francisco, CA, USA; UCSF School of Nursing, San Francisco, CA, USA
| | - D David
- San Francisco VA Medical Center, San Francisco, CA, USA; UCSF School of Nursing, Dept. of Community Health Systems, San Francisco, CA, USA
| | - S J Lee
- San Francisco VA Medical Center, San Francisco, CA, USA; UCSF School of Medicine, Division of Geriatrics, San Francisco, CA, USA
| | - C Ritchie
- UCSF School of Medicine, Division of Geriatrics, San Francisco, CA, USA
| | - C Stephens
- UCSF School of Nursing, Dept. of Community Health Systems, San Francisco, CA, USA
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Halifax E, Miaskowski C, Wallhagen M. Certified Nursing Assistants' Understanding of Nursing Home Residents' Pain. J Gerontol Nurs 2018; 44:29-36. [PMID: 29437185 DOI: 10.3928/00989134-20180131-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 12/19/2017] [Indexed: 01/12/2023]
Abstract
Pain is a significant problem for nursing home residents, yet its assessment is complex. Certified nursing assistants (CNAs) spend significant time with residents, but their role in understanding residents' pain is largely unexplored. The current qualitative grounded theory study analyzed interviews with 16 CNAs who described their experiences caring for residents in pain. Findings revealed how CNAs understood, recognized, interpreted, and responded to residents' pain. CNAs were found to differentiate between pain that they considered normal (everyday pain) and new pain judged significant enough to report to licensed nurses. CNAs exhibited a holistic understanding of pain, knowledge of strategies to identify and interpret pain, and actions to independently mitigate and report pain. Although additional confirmatory data are needed, the differentiation made between everyday and reportable pain may have important clinical implications suggesting that CNAs should always report to a licensed nurse when they perceive or suspect that residents have pain. [Journal of Gerontological Nursing, 44(4), 29-36.].
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Stephens CE, Hunt LJ, Bui N, Halifax E, Ritchie CS, Lee SJ. Palliative Care Eligibility, Symptom Burden, and Quality-of-Life Ratings in Nursing Home Residents. JAMA Intern Med 2018; 178:141-142. [PMID: 29159368 PMCID: PMC5833507 DOI: 10.1001/jamainternmed.2017.6299] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study identifies which nursing home residents are eligible for palliative care services, describes their characteristics, and delineates resident and family perceptions regarding symptoms and quality of life.
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Affiliation(s)
- Caroline E Stephens
- Department of Community Health Systems, University of California, San Francisco
| | - Lauren J Hunt
- Department of Physiological Nursing, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Nhat Bui
- Asian Health Services, Oakland, California
| | - Elizabeth Halifax
- Department of Community Health Systems, University of California, San Francisco
| | - Christine S Ritchie
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | - Sei J Lee
- Division of Geriatrics, Department of Medicine, University of California, San Francisco.,San Francisco Veterans Affairs Medical Center, San Francisco, California
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Kayser-Jones J, Kris AE, Lim KC, Walent RJ, Halifax E, Paul SM. Pressure Ulcers Among Terminally Ill Nursing Home Residents. Res Gerontol Nurs 2008; 1:14-24. [DOI: 10.3928/19404921-20080101-06] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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