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Nursing homes experience high nursing staff turnover. Nursing staff in nursing homes is comprised of gray and blue collar workers that include registered nurses (RNs), licensed practical nurses (LPNs), and certified nurse assistants (CNAs). The relationship between human resource management (HRM)practices, organizational culture, and nursing staff turnover is examined in underresourced (high Medicaid) nursing homes. Survey data from 348 nursing home administrators (NHAs) of USA high Medicaid (85% or higher) facilities were merged with secondary data sources for 2017–2018. The dependent variables (nursing staff turnover rates) consisted of the percentages of RNs, LPNs, and CNAs that had voluntarily quit the organization during the past year. The independent variables were: (1) HRM practices (employee-centered and high involvement practices); and (2) organizational culture: clan, market, hierarchical, and non-dominant. Organizational and market variables were controlled for. Data were modeled using Poisson log-linear regression, and propensity score weights were used to adjust for potential survey non-response bias. Results show high involvement HRM practices and having a clan culture are associated with lower RN, LPN, and CNA staffing turnover. Study findings suggest that organizational culture and HRM practices may be instrumental in reducing nursing turnover in underresourced nursing homes.

The aim of this research is to provide insight into how organizations can co-create value with family members engaged in service journeys of customers experiencing vulnerabilities, thereby paying attention to their organizational practices (i.e. recursive or routinized patterns of organizational actions and behaviors).

To investigate, this research relies upon a multiple case study in a group of nursing homes in Flanders that had the ambition to engage family members in service journeys of their loved ones while measuring their value perceptions as a performance indicator (here, satisfaction with nursing home services).

The case evidence shows that nursing homes co-create value with family members through caring practices that focus on their role as secondary customers (i.e. welcoming, connecting and embedding) and empowering practices that focus on their role as partial employees (i.e. teaming up, informing and listening practices). However, the way in which the different caring and empowering practices are enacted by the nursing home and its staff affects their value co-creation potential.

By focusing on the practices with which organizations can co-create value with family members engaged in service journeys of their loved ones, this research bridges the service literature with its attention for value co-creation practices and the literature on customers experiencing vulnerabilities with its focus on extended customer entities.

Older adults living in nursing homes may become vulnerable because of errors or incidents; it is necessary to create a positive safety culture to minimise such occurrences. However, safety culture is still a prevailing issue in Indonesian nursing homes. This study aims to examine factors related to resident safety culture in nursing homes located in Indonesia.

This study used a cross-sectional research design and involved 13 nursing homes in East Java province, Indonesia. Multistage cluster samplings were used to determine the respondents of this study. The respondents included 219 employees: managers, health care, supportive and administrative staff. The Indonesian version of the Safety Attitudes Questionnaire was used to measure safety culture.

Most of the respondents (68.5%) had a positive perspective on the nursing home’s safety culture. Staffs who had worked for six to ten years in the nursing home were 17.07 times more likely to have positive perspective on safety culture with a p-value of 0.0002. Respondents who gave direct care also had a positive perception of safety culture with a p-value of 0.008.

Broader insight into safety culture needs to be provided to all staff in the nursing home. Safety topics should be included in the orientation session for new staff.

The staff’s work experience and direct care have a significant connection to safety culture.

Residents in under-resourced/high-Medicaid (85% or higher) nursing homes on average receive care from relatively lower quality providers and have worse health outcomes, which may increase the risk of higher COVID-19 incidence. This study aims to evaluate if having a culture that encourages employee empowerment results in better quality (lower COVID-19 deaths) in times of crisis, such as the current pandemic. The study combined primary survey data from 391 Directors of Nursing (response rate of 37%), with Centers for Medicare and Medicaid Services’ (CMS) Nursing Home COVID-19 Public File, LTCFocus, Area Health Resource File, and Nursing Home Compare. The dependent variable consisted of the number of COVID-19 death as of November 25, 2021. The independent variables consisted of Likert scale for employee empowerment (Cronbach alpha= 0.82). Control variables consisted of organizational factors (e.g., size, location, and ownership), as well as community factors (e.g., poverty, unemployment, and competition). The results indicated that one unit increase in employee empowerment was associated with 6% lower likelihood of having COVID-19 deaths. Nursing homes, particularly those under-resourced, face difficulty improving the quality of care due to financial constraints. However, the results suggest that adopting a culture that fosters employee empowerment may give nursing homes an edge in improving quality outcomes in crises.

Older people living in nursing homes have complex care needs and frequently need specialists’ advice and support that can be challenging to deliver in a rural setting. The aim of this paper is to describe a model of integrated care in a rural area supported by a nurse case manager.

A real-world evidence study of people living in Ribes de Freser nursing home, was conducted between specific timeframes in 2019 and 2022, comparing the casemix and outcomes of a traditional care model with the integrated interdisciplinary model.

The integrated care model led to a significant reduction in transfers to the emergency department, hospitalisations, outpatient medical visits and a reduction in the number of medicines. In addition, the number of residents receiving end-of-life care at the nursing home showed a substantial increase.

This case study contributes valuable evidence supporting the implementation of an integrated model of nurse case manager support in nursing homes, particularly in the rural contexts, where access to specialist medical staff may be limited. The findings highlight the potential benefits of person-centred integrated care for older adults, addressing their complex needs and improving end-of-life care in nursing home settings.

This paper aims to disseminate the results of research aiming to identify the prevalence of dysphagia and related clinical factors in nursing home residents.

A cross-sectional descriptive study was developed, including 99 residents in five nursing homes. A sociodemographic questionnaire and the Gugging Swallowing Screen for dysphagia screening were used for data collection.

The prevalence of dysphagia was 59.59%. A significant correlation was found between dysphagia and worse scores for fall risk, pressure ulcer, level of independence for activities of daily living and cognitive functioning.

Results should be interpreted carefully due to sample size and specific country context. A larger sample must be achieved in further research.

Nurses must receive proper training to perform systematic dysphagia screening, and it should be considered, given the high prevalence, the inclusion of professionals specially trained for rehabilitating dysphagic residents in nursing home teams.

The social and economic burden of dysphagia, in addition to all the implications on the person’s quality of life, requires a differentiated focus on this issue by nursing home managers.

Nursing homes have nurses providing health care; however, trained professionals for dysphagia treatment commonly are not. These results highlight the importance of systematic screening for dysphagia in all residents, thus promoting timely intervention to prevent respiratory and nutritional complications.

High-quality nursing home (NH) care has long been a challenge within the United States. For decades, policymakers at the state and federal levels have adopted and implemented regulations to target critical components of NH care outcomes. Simultaneously, our delivery system continues to change the role of NHs in patient care. For example, more acute patients are cared for in NHs, and the Center for Medicare and Medicaid Services (CMS) has implemented value payment programs targeting NH settings. As a part of these growing pressures from the broader healthcare delivery system, the culture-change movement has emerged among NHs over the past two decades, prompting NHs to embody more person-centered care as well as promote settings which resemble someone's home, as opposed to institutionalized healthcare settings.

Researchers have linked culture change to high-quality outcomes and the ability to adapt and respond to the ever-changing pressures brought on by changes in our regulatory and delivery system. Making enduring culture change within organizations has long been a challenge and focus in NHs. Despite research suggesting that culture-change initiatives that promote greater resident-centered care are associated with several desirable patient outcomes, their adoption and implementation by NHs are resource intensive, and research has shown that NHs with high percentages of low-income residents are especially challenged to adopt these initiatives.

This chapter takes a novel approach to examine factors that impact the adoption of culture-change initiatives by assessing knowledge management and the role of knowledge management activities in promoting the adoption of innovative care delivery models among under-resourced NHs throughout the United States. Using primary data from a survey of NH administrators, we conducted logistic regression models to assess the relationship between knowledge management and the adoption of a culture-change initiative as well as whether these relationships were moderated by leadership and staffing stability. Our study found that NHs were more likely to adopt a culture-change initiative when they had more robust knowledge management activities. Moreover, knowledge management activities were particularly effective at promoting adoption in NHs that struggle with leadership and nursing staff instability. Our findings support the notion that knowledge management activities can help NHs acquire and mobilize informational resources to support the adoption of care delivery innovations, thus highlighting opportunities to more effectively target efforts to stimulate the adoption and spread of these initiatives.

Research-based knowledge on homecare nursing is scarce and further information is warranted about citizens’ perceptions of receiving home care under existing conditions. The purpose of this study was to investigate citizen experiences with health-care professionals in the time allotted for home care.

A questionnaire survey was distributed to 348 citizens receiving home care. The questionnaire consisted of questions whether the citizens experienced that enough time was available during the homecare visit and how the conversation and care relationship with the health-care professionals were experienced. The differences in responses were analysed using Fisher’s Exact Tests.

Overall, 94% of the citizens reported that sufficient time had been available and that care relationship and conversation with the health-care professionals had been positive during the homecare visit. However, the findings indicated that citizens aged more than +76 years and citizens with a high educational level were more prone to report that the nurses did not spend enough time during the home visit.

The findings offer useful insights for the professionals in delivering appropriate home care. Listening to citizens’ wishes and needs for home care could lead to better individualised care. Especially the youngest and oldest of the citizens seem to have specific experiences that call for further investigation.

Many countries have developed hospital-at-home (HAH) models to bring hospital services closer to home. Although some countries already have a long tradition of HAH for adults, paediatric HAH has been developed more recently. Specificities of paediatric care make it difficult to directly extend an adult HAH model to the paediatric population. The objective of this study is to compare the organisation of paediatric HAH in four countries: France, Australia (states of Victoria and New South Wales), the Netherlands and Belgium. Ultimately, lessons can be drawn for further development in the countries analysed and/or for implementation in other countries.

Legal documents and other grey literature were analysed to describe the legal context for the provision of paediatric HAH in the selected countries. In addition, semi-structured in-depth interviews were conducted with key informants from paediatric HAH organisations in these countries, addressing the following topics: historical background, legal framework, functioning of HAH models, workforce, number of services, profile of children, type of care activities, funding, coordination with other providers and quality of care. Results were reviewed by a content expert from the respective country.

Organisational differences were highlighted in terms of coordinating actor (hospital or home nursing care services), decision-making process, range of clinical conditions treated, territorial organisation, qualifications and expertise of the team members, medical expertise, financing, responsibilities, etc.

There is no single preferred model for the provision of HAH care for children. There is a large variety in almost all aspects of organisation. There are, however, also some common characteristics across the different models. Notably, paediatric expertise of nurses within the HAH team was considered indispensable in all programmes.

While the main emotional labor strategies are well-documented, the manner in which professionals navigate emotional rules within the workplace and effectively perform emotional labor is less understood. With this contribution, I aim to unveil “the good, the bad and the ugly” of emotional labor as a dynamic theatrical performance.

Focusing on three geriatric long-term care units within a French public hospital, this qualitative study relies on two sets of data (observation and interviews). Deeply rooted within the field of study, the chosen methodological approach substantializes the subtle hues of the emotional experience at work and targets resonance rather than generalization.

Using the theatrical metaphor, this research underlines the role of space in the practice of emotional labor in a unique way. It identifies the main emotionalized zones or emotional regions (front, back, transitional, mixed) and details their characteristics, before unearthing the nonlinearity and polyphonic quality of emotional labor performance and the versatility needed to that effect. Indeed, this research shows how health-care professionals juggle with the specificities of each region, as well as how space generates both constraints and resources. By combining static and dynamic prisms, diverse instantiations of hybridity and spatial in-betweens, anchored in liminality and trajectories, are revealed.

This research adds to the current body of literature on the concept of emotional labor by shedding light on its highly dynamic and interactional nature, revealing different levels of porosity between emotional regions and how the characteristics of each type of area can taint others and increase/decrease the occupational health costs of emotional labor. The study also raises questions about the interplay of emotional labor performance with the level of humanization/dehumanization of elderly people. Given the global demographics about an aging population, this gives food for thought at a social level.