JAMDA
Volume 10, Issue 1 , Pages 11-20 , January 2009

Certified Nursing Assistants' Perceptions of Nursing Home Patient Safety Culture: Is There a Relationship to Clinical Outcomes?

  • Alice F. Bonner, PhD, RN

      Affiliations

    • University of Massachusetts, Graduate School of Nursing, Worcester, MA
    • Massachusetts Long Term Care Foundation, Newton Lower Falls, MA
    • Corresponding Author InformationAddress correspondence to Alice F. Bonner, PhD, RN, Massachusetts Long Term Care Foundation, 2310 Washington Street, Suite 300, Newton Lower Falls, MA 02462
    • ,
  • Nicholas G. Castle, PhD

      Affiliations

    • Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
    • ,
  • Aiju Men, MS

      Affiliations

    • Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
    • ,
  • Steven M. Handler, MD, MS

      Affiliations

    • Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA
    • Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA

References 

  1. Castle NG. Nurse aides' ratings of the resident safety culture in nursing homes. Int J Qual Health Care. 2006;18(5):370–376
  2. Kohn L, Corrigan J, Donaldson M. To err is human: Building a safer health system. Washington, DC: National Academy Press; 2000;
  3. Aspden P, Corrigan J, Wolcott J. Patient Safety, Achieving a New Standard for Care. Washington, DC: The National Academies Press; 2004;
  4. Lee T. Assessment of safety culture at a nuclear reprocessing plant. Work & Stress. 1998;12:217–237
  5. Singer SJ, Gaba DM, Geppert JJ, et al. The culture of safety: Results of an organization-wide survey in 15 California hospitals. Qual Saf Health Care. 2003;12(2):112–118
  6. Sexton JB, Helmreich RL, Neilands TB, et al. The Safety Attitudes Questionnaire (Psychometric properties, benchmarking data and emerging research: BMC Health Services Research). www.biomedcentral.com/1472-6963/6/44Accessed September 13, 2006
  7. Sorra JS, Nieva VF. Hospital survey on patient safety culture. Rockville, MD: Agency for Healthcare Research and Quality; 2004;AHRQ publication no. 04-0041
  8. Bonner A, Castle NG, Perera S, Handler S. Patient safety culture: A review of the nursing home literature and recommendations for practice. Annals of Long Term Care: Clinical Care and Aging. 2008;16(3):18–22
  9. Anderson RA, Hsieh PC, Su HF. Resource allocation and resident outcomes in nursing homes: Comparisons between the best and worst. Res Nurs Health. 1998;21(4):297–313
  10. Harrington C, Swan JH, Carrillo H. Nurse staffing levels and Medicaid reimbursement rates in nursing facilities. Health Serv Res. 2007;42(3 Pt 1):1105–1129
  11. Rantz MJ, Hicks L, Grando V, et al. Nursing home quality, cost, staffing, and staff mix. Gerontologist. 2004;44(1):24–38
  12. Schnelle JF, Simmons SF, Harrington C, et al. Relationship of nursing home staffing to quality of care. Health Serv Res. 2004;39(2):225–250
  13. Boockvar K, Fishman E, Kyriacou CK, et al. Adverse events due to discontinuations in drug use and dose changes in patients transferred between acute and long-term care facilities. Arch Intern Med. 2004;164(5):545–550
  14. Coleman EA, Parry C, Chalmers S, Min S-J. The care transitions intervention: Results of a randomized controlled trial. Arch Intern Med. 2006;166(17):1822–1828
  15. Vira T, Colquhoun M, Etchells E. Reconcilable differences: Correcting medication errors at hospital admission and discharge. Qual Saf Health Care. 2006;15(2):122–126
  16. Bowers BJ, Esmond S, Jacobson N. The relationship between staffing and quality in long-term care facilities: Exploring the views of nurse aides. J Nurs Care Qual. 2000;14(4):55–64quiz 73–55
  17. Cadogan MP, Franzi C, Osterweil D, Hill T. Barriers to effective communication in skilled nursing facilities: Differences in perception between nurses and physicians. J Am Geriatr Soc. 1999;47(1):71–75
  18. Anderson RA, Issel LM, McDaniel RR. Nursing homes as complex adaptive systems: Relationship between management practice and resident outcomes. Nurs Res. 2003;52(1):12–21
  19. Gurwitz J, Field T, Judge J. The incidence of adverse drug events in two large academic long-term care facilities. Am J Med. 2005;118:251–258
  20. Handler SM, Wright RM, Ruby CM, Hanlon JT. Epidemiology of medication-related adverse events in nursing homes. Am J Geriatr Pharmacother. 2006;4(3):264–272
  21. Hofmann D, Mark B. An investigation of the relationship between safety climate and medication errors as well as other nurse and patient outcomes. Personnel Psychology. 2006;59:847–869
  22. Itoh K, Abe T, Andersen H. A survey of safety culture in hospitals including staff attitudes about incident reporting. Paper presented at: Workshop on the Investigation and Reporting of Incidents and Accidents; Glasgow, Scotland; June 19, 2002.
  23. Pronovost P, Weast B, Rosenstein B, et al. Implementing and validating a comprehensive unit-based safety program. Journal of Patient Safety. 2005;1(1):33–40
  24. Beck C, Ortigara A, Mercer S, Shue V. Enabling and empowering certified nursing assistants for quality dementia care. Int J Geriatr Psychiatry. 1999;14(3):197–211discussion 211–192
  25. Bonner A. Falling Into Place: A practical approach to interdisciplinary education on falls prevention in long-term care. Annals of Long Term Care: Clinical Care and Aging. 2006;14(6):21–29
  26. Bates-Jensen BM, Cadogan M, Osterweil D, et al. The minimum data set pressure ulcer indicator: Does it reflect differences in care processes related to pressure ulcer prevention and treatment in nursing homes?. J Am Geriatr Soc. 2003;51(9):1203–1212
  27. Schnelle JF, Bates-Jensen BM, Levy-Storms L, et al. The minimum data set prevalence of restraint quality indicator: does it reflect differences in care?. Gerontologist. 2004;44(2):245–255
  28. Berlowitz D, Frantz RA. Implementing best practices in pressure ulcer care: The role of continuous quality improvement. J Am Med Dir Assoc. 2007;8(3 Suppl):S37–S41
  29. Morris JN, Moore T, Jones R, et al. Validation of long-term and post-acute care quality indicators (executive summary of report to CMS). Cambridge, MA: Abt Associates, Inc; 2002;500-95-0062/TO#2
  30. Center for Medicare and Medicaid Services. Nursing Home Compare. March 22, 2007; National Web site for public reporting of nursing home quality indicators http://www.medicare.gov/NHCompare/home.aspAccessed July 8, 2007
  31. Donabedian A. An Introduction to Quality Assurance in Health Care. New York, NY: Oxford University Press; 2003;
  32. Stone P, Harrison MI, Feldman P, et al. Organizational Climate of Staff Working Conditions and Safety—An Integrative Model (Advances in Patient Safety: From Research to Implementation, volume 1, pages 467-481). http://www.ahrq.gov/downloads/put/advances/vol1/Stone.pdfAccessed October 1, 2006
  33. Mor V. Improving the quality of long-term care with better information. Milbank Q. 2005;83(3):333–364
  34. Ryan J, Stone RI, Raynor CR. Using large data sets in long-term care to measure and improve quality. Nurs Outlook. 2004;52(1):38–44
  35. Mor V, Berg K, Angelelli J, et al. The quality of quality measurement in US nursing homes. Gerontologist. 2003;43(Spec No 2):37–46
  36. Morris JN, Nonemaker S, Murphy K, et al. A commitment to change: Revision of HCFA's RAI. J Am Geriatr Soc. 1997;45(8):1011–1016
  37. Snowden M, McCormick W, Russo J, et al. Validity and responsiveness of the Minimum Data Set. J Am Geriatr Soc. 1999;47(8):1000–1004
  38. Schnelle JF, Ouslander JG, Simmons SF. Direct observations of nursing home care quality: Does care change when observed?. J Am Med Dir Assoc. 2006;7(9):541–544
  39. Phillips CD, Shen R, Chen M, Sherman M. Evaluating nursing home performance indicators: An illustration exploring the impact of facilities on ADL change. Gerontologist. 2007;47(5):683–689
  40. Feng Z, Katz P, Intrator O, et al. Physician and nurse staffing in nursing homes: The role and limitations of the Online Survey Certification and Reporting (OSCAR) System. J Am Med Dir Assoc. 2005;6:27–33
  41. Bourbonniere M, Feng Z, Intrator O, et al. The use of contract licensed nursing staff in US nursing homes. Med Care Res Rev. 2006;63(1):88–109
  42. Lake ET, Cheung RB. Are patient falls and pressure ulcers sensitive to nurse staffing?. West J Nurs Res. 2006;28(6):654–677
  43. Morris JN, Fries BE, Mehr DR, et al. MDS Cognitive Performance Scale. J Gerontol. 1994;49(4):M174–M182
  44. Brannon D, Zinn JS, Mor V, Davis J. An exploration of job, organizational, and environmental factors associated with high and low nursing assistant turnover. Gerontologist. 2002;42(2):159–168discussion 157–158
  45. Mor V, Zinn J, Angelelli J, et al. Driven to tiers: Socioeconomic and racial disparities in the quality of nursing home care. Milbank Q. 2004;82(2):227–256
  46. Mor V. Defining and measuring quality outcomes in long-term care. J Am Med Dir Assoc. 2006;7:532–540
  47. Wagner LM, Capezuti E, Ouslander JG. Reporting near-miss events in nursing homes. Nurs Outlook. 2006;54(2):85–93
  48. Capezuti E, Strumpf NE, Evans LK, et al. The relationship between physical restraint removal and falls and injuries among nursing home residents. J Gerontol A Biol Sci Med Sci. 1998;53(1):M47–M52

 The authors gratefully acknowledge the support of the American Medical Directors Association (AMDA), AMDA Foundation, and Pfizer for an unrestricted Quality Improvement Award. The parent study, Examining Nursing Home Compare, was funded by the National Institutes of Health 1 RO3 AG023214-01. S.M.H. acknowledges support from the National Institutes of Health 1 KL2 RR024154-01 (NIH Roadmap Multidisciplinary Clinical Research Career Development Award Grant), and a Merck/AFAR Junior Investigator Award in Geriatric Clinical Pharmacology.

PII: S1525-8610(08)00233-8

doi: 10.1016/j.jamda.2008.06.004

JAMDA
Volume 10, Issue 1 , Pages 11-20 , January 2009

Article Tools

* Image Usage & Resolution