Sunday, January 26, 2020

High Turnover Rate in Long-Term Care in Nursing

High Turnover Rate in Long-Term Care in Nursing Lisa Krier Introduction There is a serious problem in this nation, and it is only getting worse. By the year 2030, the number of elderly in the United States, 85 years or older, is expected to reach 8.9 million (Barondess, 2007). According to the Center for Disease Control and Prevention’s website, two-thirds of people reaching the age of 65 will require the services of a long term care facility at least once during their lifetime (Harris-Kojetin, Sengupta, Park-Lee, Valverde, 2013). As the population continues to age, the population of those over the age of 65 is projected to soar to 88.5 million by the year 2050, and the oldest of the old, those 85 years and older, is estimated to reach 17.9 million and account for 4.5% of the U.S. population (Harris-Kojetin, Sengupta, Park-Lee, Valverde, 2013). The 85 and older population often have the highest disability rate and their need for long term care placement is the greatest (Harris-Kojetin, Sengupta, Park-Lee, Valverde, 2013). Unfortunately, the number of women who are 20 to 50 years old, the population most likely to provide the work force of direct care staff, is only expected to increase less than 10% during this same time (Barondess, 2007). In the United States, the shortage of direct-care staff is a serious problem that is worsening (Barondess, 2007). Recruitment and retention of direct- care staff is extremely challenging and is exacerbated by the growing division between the number of those needing care the number of those providing the care (Barondess, 2007). Discussion Long term care facilities experience very high turnover rates among direct-care staff (Barondess, 2007). This problem is costly, threatens the quality of care provided to patients, increases workloads, and can lower morale among the remaining direct-care staff, with all of this contributing to continual and increased turnover (Barondess, 2007). According to the Institute of Medicine’s website, among direct-care staff there was a 71% turnover rate nationwide in 2008 and they were more likely to not have health insurance and to use food stamps (IOM, 2008). The high turnover rate of direct-care staff costs employers on average $4.1 billion annually (IOM, 2008). Direct-care staff contributes greatly to the physical and mental health of long term care patients (Stone Wiener, 2001). Patients depend on staff for assistance with activities of daily living and direct-care staff is the ones providing this care (Stone Wiener, 2001). According to the CDC, in 2012, direct-care staff spent on average 2.46 hours per day per patient, while RNs spent 0.52 hours per day per patient, and LPNs spend 0.85 hours per day per patient (Harris-Kojetin, Sengupta, Park-Lee, Valverde, 2013). As the direct-care staff spends much time caring for the patient, real attachments between the care givers and patients can occur (Eaton, 2000). Direct-care staff potentially can help to improve the patient’s health and psychosocial functioning by providing positive interactions (Eaton, 2000). In this regard, high turnover rates in the long term care setting can affect patient care and patients may suffer both physically and emotionally as a result (Hayes et al., 2006) . Staff turnover in the long term care industry increases the cost for caring for those patients and affects the quality of care provided (Rosen, Stiehl, Mittal, Leana, 2011). In order to increase the retention of nursing assistants, administrators need to address the problem of low job satisfaction among these employees (Rosen, Stiehl, Mittal, Leana, 2011). The following is a plan of action developed to address the problem of low job satisfaction and the high turnover rate of direct-care staff. Core Competency The core competency that will be addressed is managing patient-centered care (IOM, 2003). In 2003, the Institute of Medicine identified patient centered-care as: â€Å"identify, respect, and care about patient’s differences, values, preferences, and expressed needs; relieve pain and suffering; coordinate continuous care; listen to, clearly inform, communicate with, and educate patients; share decision-making and management; and continuously advocate disease prevention, wellness, and promotion of health lifestyles, including a focus on population health† (IOM, 2003). In order for patient-centered care to be effective the staff must collaborate and coordinate care (Finkelman, 2012). Knowledge, Skills, and Attributes The KSA (Knowledge, Skills, and Attributes) that will be utilized for the Leadership Development Goal is team building conversations. High staffing turnover rates threaten the quality of care provided to patients and increases the financial burden of caring for those patients in long term care (Rosen, Mittal, Leana, 2011). When direct-care staff has been asked what promotes the best care, the staff rated communication highest (Scott-Cawiezell et al., 2004), and also rated communication as the greatest weakness in the organization (Kostiwa Meeks, 2009). Direct-care staff believes that they have a greater influence on quality of life for the patient than any other staff (Kane et al., 2006), and that high turnover rates undermine their relationships with patients (Bowers, Esmond, Jacobson, 2000). Direct-care staff believes that the quality of care for patients is reflected in the quality of care for staff by the leadership (Burke, Summers, Thompson, 2001). Given how direct-care staf f feel about their ability to affect patient care and their need to feel supported by the leadership, sitting down with them and having conversations about how best to build the team is essential (Kostiwa Meeks, 2009). Leadership SMART Goal I will examine the high turnover rate of direct-care staff in this long term care facility and meetings will take place with the direct-care staff and the management to begin building a strong team by engaging the direct-care staff in conversations regarding job satisfaction, reviewing peer-reviewed articles and credible websites, and to obtain information regarding job satisfaction from the direct-care staff through the use of employee surveys administered during the first meeting. SMART Goal Format Specifically, all direct-care staff, consisting of Certified Nursing Assistants and Medication Assistants, will sit down with management on a monthly basis to have team building discussions. The goal is to retain the direct-care staff by improving job satisfaction through providing access to authority, information, and teamwork (Boudrias, Gaudreau, Laschinger, 2004), and therefore allowing the direct-care staff to have involvement in decision-making (Kostiwa Meeks, 2009). These meetings will be scheduled during the first week of every month in the facility’s classroom and will occur at different times during the week to accommodate the direct-care staff from all of the shifts. The effects of these meetings, improvement in job satisfaction (Kostiwa Meeks, 2009) and the retention of direct-care staff (Rosen, Stiehl, Mittal, Leana, 2011) will be measured by selecting five direct-care staff members from each of the three shifts and having them participate in a series of surveys (Kostiwa Meeks, 2009). The employees selected to participate in the surveys must have completed the probationary period of employment. The first survey that will be administered is a psychological empowerment survey which consists of four categories, meaning, impact, competence, and self-determination (Spreitzer, 1995). Each category contains three questions and when all of the responses from each category are combined, an overall empowerment score is obtained (Spreitzer, 1995). Each item is rated on a seven point scale and higher scores represent opinions of increased empowerment (Spreitzer, 1995). The second survey that will be administered to the direct-care staff is the Organizat ional Cultural Inventory (Cooke Rousseau, 1988). This inventory assesses what the direct-care staff believes to be the behavioral expectations of them in the facility (Cooke Rousseau, 1988). The direct-care staff’s beliefs of service quality, commitment, role clarity, and role conflict are assessed on a scale from 1-5, or â€Å"not at all† to a â€Å"very great extent† (Cooke Rousseau, 1988). High scores are indicative of stronger validation of the construct (Cooke Rousseau, 1988). The third survey that the direct-care staff will be asked to complete is a nursing assistant job satisfaction survey (Ejaz, Noelker, Menne, Bagakas, 2008), which includes 18 items that measure the employee’s satisfaction with recognition and communication time, the time allotted to complete tasks, resources available to staff, teamwork, and leadership practices (Ejaz, Noelker, Menne, Bagakas, 2008). High levels of job satisfaction are related to high scores on the survey (Ejaz, Noelker, Menne, Bagakas, 2008). This goal is attainable as consistent meetings will take place on a monthly basis with direct-care staff and those in management. The direct-care staff will have the ability to have direct input and will have access to peer-reviewed research articles and evidence-based research provided by the management of the facility. During the first meeting, the credible websites of the Center for Disease Control (CDC, 2014) and the Institute of Medicine (IOM, 2008) will be reviewed for vital information regarding staffing issues in long term care. During the second meeting, which will take place during the first week of the second month, the research article The Relation Between Psychological Empowerment, Service Quality, and Job Satisfaction Among Certified Nursing Assistants, published in the Clinical Gerontologist (Kostiwa Meeks, 2009) will be reviewed in correlation with the results of the surveys taken the previous month. The results of the surveys will be reviewed with the direct-care st aff and an initial plan of action will be drawn. The articles Some Potential Solutions to High Direct-Care Staff Turnover Rates published in the Annuals of Long-Term Care (Barondess, 2008) and Stayers, Leavers, and Switchers Among Certified Nursing Assistants in Nursing Home: A Longitudinal Investigation of Turnover Intent, Staff Retention, and Turnover published in The Gerontologist (Rosen, Stiehl, Mittal, Leana, 2011) will be discussed and made available for the staff to review at the third meeting, taking place during the first week of the third month. After the plan of action is created, it will be discussed at each monthly meeting to determine if the plan is succeeding in the goals set forth as well as any revisions that may be necessary. This goal is realistic as perceptions of empowerment and service quality have been shown to be strongly and positively related to job satisfaction (Kostiwa Meeks, 2009). Communication with management also affects job satisfaction (Scott-Cawiezell et al., 2004) as direct-care staff has consistently rated communication as the greatest weakness of their facility (Kostiwa Meeks, 2009). Suggestions made by the direct-care staff will be reviewed with management and changes will then be implemented with input and discussion from the staff as well as management. The time frame related to this goal will consist of monthly meetings with the direct-care staff and management both present. These meetings will take place during the first week of each month, with varying times to accommodate staff from all shifts. The surveys will be administered during the meeting in the first month, and then at six month intervals to measure whether or not job satisfaction rates are increasing. The program will be evaluated at the end of the first year to determine if the job satisfaction has increased and the turnover rate has decreased. Any changes to the program will be made at the end of the first year. Conclusion As the baby boomers retire and the population is expected to become much older, with 2/3rds of individuals over the age of 65 needing long term care services at least once in their lives, it is imperative that there is a sufficient workforce to care for these individuals (Harris-Kojetin, Sengupta, Park-Lee, Valerde, 2013). As the population of women aging 20 to 50 years of age, the population most likely to provide the work force of direct-care staff, is only expected to increase less than 10% over the next 20 years, it is imperative to see job satisfaction rates improve and the turnover rates decline in this workforce (Barondess, 2007). With a comprehensive plan that includes involving the direct-care staff in the decision making process, having management and the direct-care staff participate in team building conversations on a monthly basis, and utilizing credible websites and peer-reviewed journal articles to obtain valuable information, this is one problem that can have a succe ssful resolution. References Barondess, L.H. (2007). Some potential solutions to high direct-care staff turnover rates. Annuals of Long-Term Care, 15(10). Retrieved from http://www.annalsoflongtermcare.com/article/7860 Boudrias, J. S., Gaudreau, P., Laschinger, H. K. S. (2004). Testing the structure of psychological empowerment: Does gender make a difference? Educational and Psychological Measurement, 64(5), 861-877. Bowers, B. J., Esmond, S., Jacobson, N. (2000). The relationship between staffing and quality in long-term care facilities: Exploring the views of nurse aides. Journal of Nursing Care Quality, 14(4), 55-65, 73-55. Burke, G., III, Summers, J., Thompson, T. (2001). Quality in long-term care: What we can learn from certified nursing assistants. Annuals of Long-Term Care, 9(2), 29-35. Centers for Disease Control and Prevention (2014). Fast stats: Nursing home care. Retrieved from http://www.cdc.gov/nchs/faststats/nursing-home-care.html Cooke, R. A., Rousseau, D. M. (1988). Behavioral norms and expectations: A quantitative approach to the assessment of organizational culture. Group Organization Studies, 13(3), 245-273. Eaton, S. C. (2000). Beyond ‘unloving care’: Linking human resource management and patient care quality in nursing homes. International Journal of Human Resource Management, 11(3), 591-616. Ejaz, F. K., Noelker, L. S., Menne, H. L., Bagakas, J. G. (2008). The impact of stress and support on direct-care workers’ job satisfaction. The Gerontologist, 48(Special Issue 1), 60-70. Finkelman, A. (2012). Leadership and management for nurses: Core competencies for quality care (2nd ed.). Boston, MA: Pearson. Harris-Kojetson, L., Sengupta, M., Park-Lee, E., Valverde, R. (2013). Long-term care services in the United States: 2013 overview. Hyattsville, MD: National Center for Health Statistics. Hayes, L.J., O’Brien-Pallas, L., Duffield, C., Shamian J., Buchan, J., Hughes, F., et al. (2006). Nurse turnover: A literature review. International Journal of Nursing Studies, 32(2), 237-263. Institute of Medicine (2003). Health professions education. Washington, DC: National Academies Press. Institute of Medicine (2008). Retooling for an aging America: Building the health care workforce. Retrieved from http://www.iom.edu/Reports/2008/Retooling-for-an-Aging-America-Building-the-Health-Care-Workforce.aspx Kane, R. L., Rockwood, T., Hyer, K., Desjardins, K., Brassard, A., Gessert C., et al. (2006). Nursing home staff’s perceived ability to influence quality of life. Journal of Nursing Care Quality, 21(3), 248-255. Kostiwa, I.M., Meeks, S., (2009). The relation between psychological empowerment, service quality, and job satisfaction among certified nursing assistants. Clinical Gerontologist, 32, 276-292. doi:10.1080/07317110902895309 Rosen, J., Mittal, E.M., Leana, C.R. (2011). Stayers, leavers, and switchers among certified nursing assistants in nursing home: A longitudinal investigation of turnover intent, staff retention, and turnover. The Gerontologist, 51(5), 597-609. Scott-Cawiezell, J., Schenkman, M., Moore, L. Vojir, C., Connoly, R. P., Pratt, M., et al. (2004). Exploring nursing home staff’s perceptions of communication and leadership to facilitate quality improvement. Journal of Nursing Care Quality, 19(3), 242-252. Spreitzer, G. M. (1995). Psychological empowerment in the workplace: Dimensions, measurement and validation. Academy of Management Journal, 38(5), 1442. Stone, R. I., Wiener, J. M. (2001). Who will care for us? Addressing the long-term care workforce crisis. Washington, DC: The Urban Institute.

Saturday, January 18, 2020

Functionalist Perspective

Functionalist Perspective on Family Meeting The significant event I have chosen to observe using my new sociological lenses from a functionalist perspective is our family meeting due to preparations for Aunty Mal’s 21st birthday party. All age groups from grandparents to parents and children have gathered here at Opa and Oma’s house for one purpose and that is to plan and host the most fun and memorable birthday party.Our grandparents decided to have the party at their house seeing that it holds all our childhood memories, is easy to find, has enough space for our large amount of gathering family and friends and they also wanted to show off their newly renovated two-storey house. Everyone has been divided into groups and given certain roles to play and contributions to make. I will express my experience from these preparations and the celebration of one of our family member’s special day of her life. Turning 21 comes with expectations, it is the age where you are given a key and the key symbolises the ‘beginning or entering’ to a new matured world† or so the elder’s say. The first point I will talk about is the roles played by each family member. Secondly are the interactions between individuals within the groups, interactions between different groups and the interactions between the groups and guests. Lastly is the outcome of this experience.So by the end of my essay I hope you have an idea or you have managed to see through my sociological lenses of my experience from a functionalist perspective. First of all there were six groups we had been divided into. There was the children’s group, who were to choose games to play or movies to watch to keep them entertained and out of the grown-ups area. Then there was the girl’s group (I was in this group) who were given the role of decorations including cleaning up the house, setting up the tables which must have matching plates and cups and wrapping the cha irs when they arrived.The boy’s group were given the role of setting the lights, chairs, clearing out the backyard and providing the sound system including the DJ and by requests of the elderly people, they were to mix it up and have both old and modern music played. The men’s group were given the role of providing drinks and ice. The women’s group were obviously given the role of preparing the food and having all our mothers there, they had an advantage of knowing what we wanted to eat. Finally there was the elderly people’s group who were in charge of the guest list, tasting the food and nsuring everything is done and was in place. Secondly I witnessed interactions between individuals within groups. Through laughter individuals hit it off well seeing that they were within their own age groups and having the same idea or similar makes it easier to connect with each other. There was the interaction between different groups and then the problem started e. g. there was a disagreement between the girls and boys group about what songs are played, whether by a female or male artist.We came to an agreement that satisfied both groups. There was also the interaction between groups and guests. Serving with a smile by individuals in groups and cheerful compliments from guests on one side while catching up on gossips or mocking whoever is the night’s victim on the other. Endless conversations between duos, groups of threesome or more people interacting and moving from one circle to another meant that they were enjoying each other’s company and wanted to get to know others.Lastly as the night came to an end, the birthday girl said a little speech and she touched up on ‘importance of family and how seeing family and friends enjoying themselves and each other’s company makes puts a smile on her face’. She thanked her family and friends for being there to help celebrate her 21st birthday. She also mentioned Ã¢â‚¬Ë œthe night being fun and memorable and wherever she goes she will cherish the moments with her family and friends. The celebration would not have been possible if not for the hard work and input of her family.She is the woman she is today thanks to her family and she would not ask for anything else as she has everything she needs or wants in them. She is happy, so is everyone else and they are pleased with themselves and without everyone having a function the night would not have ended well. To conclude, due to individuals and groups putting in, playing a role or having a function to contribute to, the night has turned out to be successful. With each individual in groups playing their roles it has resulted in a smooth fun party and cherished memories.Without the interactions of individuals or groups the night would have been lame and boring and even though there was one misunderstanding they managed to make both sides satisfied. If one group had not played their role there would hav e been a conflict and the whole family preparation would have been ruined. The main point is that from my functionalist perspective, the purpose was achieved, that is to have a fun and memorable party. Socialising and interaction between individuals and groups contributed to the smoothly planned nights guest’s departing happily and all functions have been played accordingly. Thank you

Friday, January 10, 2020

DDoS Attack

A distributed denial-of-service (DDoS) attack is one in which a multitude of compromised systems attack a single target, thereby causing denial of service for users of the targeted system. The flood of incoming messages to the target system essentially forces it to shut down, thereby denying service to the system to legitimate users. In a typical DDoS attack, the assailant begins by exploiting a vulnerability in one computer system and making it the DDoS master. The attack master, also known as the botmaster, identifies and identifies and infects other vulnerable systems with alware.Eventually, the assailant Instructs the controlled machines to launch an attack against a specified target. There are two types of DDoS attacks: a network-centric attack which overloads a service by using up bandwidth and an application-layer attack which overloads a service or database with application calls. The Inundation of packets to the target causes a denial of service. While the media tends to foc us on the target of a DDoS attack as the vlctlm, In reality there are many vlctlms In a DDoS attack the final arget and as well the systems controlled by the intruder.Although the owners of co- opted computers are typically unaware that their computers have been compromised, they are nevertheless likely to suffer a degradation of service and not work well. A computer under the control of an intruder is known as a zombie or bot. A group of co-opted computers is known as a botnet or a zombie army. Both Kaspersky Labs and Symantec have identified botnets not spam, viruses, or worms as the biggest threat to Internet security

Thursday, January 2, 2020

Using Historic Context in Analysis and Interpretation

Historical context is an important part of life and literature, and without it, memories, stories, and characters have less meaning. Historical context deals with the details that surround an occurrence. In more technical terms, historical context refers to the social, religious, economic, and political conditions that existed during a certain time and place. Basically, its all the details of the time and place in which a situation occurs, and those details are what enable us to interpret and analyze works or events of the past, or even the future, rather than merely judge them by contemporary standards. In literature, a strong understanding of the historical context behind a works creation can give us a better understanding of and appreciation for the narrative. In analyzing historical events, context can help us understand what motivates people to behave as they did. Put another way, context is what gives meaning to the details. Its important, however, that you dont confuse context with cause. Cause is the action that creates an outcome; context is the environment in which that action and outcome occur.   Words and Deeds Whether dealing with fact or fiction, historical context is important when interpreting behavior and speech. Consider the following sentence which, devoid of context, sounds innocent enough: Sally hid her hands behind her back and crossed her fingers before she answered. But imagine that this statement comes from a transcript of court documents in Salem, Mass., in 1692, during the famed Salem Witch Trials. Religious fervor was at an extreme, and villagers were nearly obsessed with the devil and witchcraft. At that time, if a young woman were to tell a lie, it was fodder for hysteria and a violent reaction. A reader would assume that poor Sally was a candidate for the gallows. Now, imagine youre reading a letter from a mother that contains this sentence: My daughter will be heading to California shortly after she marries. How much information does this statement give us? Not much, until we consider when it was written. Should we discover that the letter was written in 1849, we will realize that one sentence can sometimes say a lot. A young woman heading for California in 1849 might be following her husband on a treacherous treasure-seeking expedition for the gold rush. This mother would probably be quite fearful for her child, and she would know that it would be a very long time before shed see her daughter again, if ever.   Bettmann/Getty Images Historical Context in Literature   No work of literature can be fully appreciated or understood without historical context. What may seem nonsensical or even offensive to contemporary sensibilities, might actually  be interpreted in a completely different manner by considering the era it is from. A good example is Mark Twains  Adventures of Huckleberry Finn, published in 1885. It is considered an enduring work of American literature and a biting social satire. But it is also criticized by modern critics for its casual use of a racial epithet to describe Hucks friend Jim, an escaped slave. Such language is shocking and offensive to many readers today, but in the context of the day, it was​ the commonplace language for many. Back in the mid-1880s, when attitudes toward the newly liberated African-American slaves were often indifferent at best and hostile at worst, the casual use of such racial epithets wouldnt have been considered unusual. In fact, what is actually more surprising, given the historical context of when the novel was written, is Hucks treating Jim not as his inferior but as his equal—something rarely portrayed in the literature of the time. Similarly, Mary Shelleys Frankenstein  cannot be fully appreciated by a reader who is unaware of the Romantic movement that took place in art and literature in the early 19th century. It was a time of rapid social and political upheaval in Europe when lives were transformed by the technological disruptions of the Industrial Age.   The Romantics captured the publics sense of isolation and fear that many experienced as a result of these social changes. Frankenstein becomes more than a good monster story, it becomes an allegory for how technology can destroy us.   Other Uses of Historical Context Scholars and educators rely on historical context to analyze and interpret works of art, literature, music, dance, and poetry. Architects and builders rely on it when designing new structures and restoring existing buildings. Judges may use it to interpret the law, historians to understand the past. Any time critical analysis is required, you may need to consider historical context as well. Without historical context, we are only seeing a piece of the scene and not fully understanding the influence of the time and place in which a situation occurred.