Relationship Between Nurse Staffing and Quality of Care in Louisiana Nursing Homes by Veronica Kercado, Ph.D.

As Chair of the Faculty Dissertation Committee for Dr. Veronica Kercado, I am pleased to share the ABSTRACT of her dissertation, completed in April, 2016 at Walden University.  Dr. Jim Goes served as   Committee Member.

Abstract

In 2014, Louisiana experienced substantive issues with quality of care in nursing homes. The state had the lowest nurse staffing level among all states, and 7,666 deficiencies for immediate jeopardy violations were recorded from 2011 to 2013. Despite ample research on nurse staffing and quality of care, there is no consensus on how higher nurse staffing relates to quality. The purpose of this quantitative, correlational research was to determine the relationship between nurse staffing levels and quality measures in Louisiana. Donabedian’s category structure, process, and outcome was the conceptual framework used to develop the research questions. The data included the quality of care deficiency score and the quality measures found in the Centers for Medicare and Medicaid datasets. The quality measures were the deficiencies and the prevalence of nursing home residents with pressure ulcers, urinary tract infections, and physical restraints. Generalized linear models were used to analyze the relationship between nurse staffing levels and the quality measures. The findings suggested that RNs, nonprofits, chain-affiliated nursing homes, and smaller facilities are important to improve the quality of care in Louisiana nursing homes. These variables were associated with fewer quality of care deficiencies and fewer pressure ulcers. These findings have implications for social change. This information may help inform and direct policy makers in the development and implementation of Medicaid-managed long-term services and supports programs in order to improve the quality of care of a vulnerable population: the elderly and disabled.

The Aftermath of Violence: The Lived Experience Phenomena of Assult in Nursing by Kathleen Clark, RN, Ph.D.

February, 2016

As Chair of Dr, Clark's Faculty Dissertation Committee, I am pleased to present the Abstract of her  Ph.D. Dissertation from Walden University.  Drs. Jeanne Connors and Raymond Thron served as Members of the Faculty Dissertation Committee.

Abstract

Despite the high incidence of violence directed at registered nurses while on duty, there is limited qualitative data that explores the lived experience of returning to the workplace after an assaultive incident. This phenomenological study sought to explore and analyze the phenomena of registered nurses who are employed in high-risk settings. The research questions considered the detailed descriptions of the experiences of nurses returning to the workplace. The conceptual framework was resiliency, as these participants continued to survive and thrive after the adverse assaultive events. Data were collected using in-depth interviews from purposeful sampling. Nine registered nurses working in the high risk areas of inpatient psychiatry and emergency departments provided detailed descriptions about the phenomena. Data management was an inductive, iterative analysis completed and facilitated by the use of NVivo 10 software program. The study found that participants had a brief emotional response post assault mitigated by the community of nursing personnel from their immediate surroundings and felt that assault was “part of the job.” Providing a true culture of safety would include enhancements to the internal community of bedside nursing practice. In addition, research is needed on interventions that can effectively enhance the internal community after assault by patients. This study contributes to positive social change by providing registered nurses, an oppressed group, a voice to mitigate negative consequences associated with assault in the hospital setting.