This project takes an innovative approach to understanding quality of care in nursing homes by providing a conceptualization and measurement strategy of nursing practice models (NPMs), and considers their value in predicting resident well-being. NPMs describe the structural and contextual features of nursing practice. The nursing practice model includes both the structural features of the nursing staff (who is providing the care, how they organize to do it, with what resources), and the value context (how is the resident viewed, what is the goal and scope of practice) in which care is delivered. the NPM provides a framework for the design and delivery of care to elderly nursing home residents. Although NPMs are widely discussed in the nursing literature, no commonly accepted definition or measurement technique exists. Pilot work has specified the elements of the NPM in acute care settings. Eight experts in gerontological nursing will participate in a model- building session to elicit the salient dimensions of the NPM in long- term care, and develop measurement strategies for each dimension, combining them into an index of NPMs. Such an index may then be used to study the effects of NPM configuration on resident outcomes, and ultimately, to prescribe appropriate NPMs for nursing homes. Once constructed, the index will be validated on 40 nursing home units. Following validation, the index will be used in conjunction with data collection on resident outcomes on 10 residents from each of 40 units. Statistical analysis will be used to ascertain the affect of the NPM on selected outcomes, including functional status and psychosocial well- being. The last phase of the study will include preparation of guidelines for the implementation of appropriate and outcome-enhancing NPMs in long- term care settings.
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