The Moyne Nursing Home

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The Moyne Nursing Home, The Moyne, Enniscorthy, Wexford

The Moyne Nursing Home, The Moyne, Enniscorthy, Wexford

decorated. Moyne Nursing Home is a single-storey, purpose built centre with ten single and eight twin rooms. Three bedrooms had en-suite facilities. There are additional wheelchair accessible toilets located around the building. The centre has two main day rooms, a dining room and a conservatory. A kitchen, pantry, cleaning room, laundry room, sluice room and equipment storage room, the office of the person in charge and nurse’s office complete the accommodation.

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The Moyne Nursing Home, The Moyne, Enniscorthy, Wexford

The Moyne Nursing Home, The Moyne, Enniscorthy, Wexford

There were suitable arrangements in place to meet the health and nursing needs of residents with dementia. Each resident’s needs were determined by comprehensive assessment with care plans developed based on identified needs. Care plans were updated in line with residents changing needs. Residents and their families, where appropriate were involved in the care planning process, including end of life care plans which reflected the wishes of residents with dementia. The nutritional and hydration needs of residents with dementia were met. Staff cared for residents receiving percutaneous endoscopic gastrostomy (PEG) tube replacement. The acting person in charge told inspectors that the nursing team supported by residents’ GPs were developing their practice to include care procedures that would prevent unnecessary hospital admissions. For example, provision of subcutaneous fluid replacement. Residents had a choice of General Practitioner (GP) and some residents continued to have their medical care needs met by their GP prior to their admission to the centre. Residents also had access to allied healthcare professionals including physiotherapy, occupational therapy, dietetic, speech and language therapy, dental, podiatry and ophthalmology services. Residents in the centre also had access to the specialist mental health of later life services. A member of this team assessed residents referred to them and reviewed other residents on a regular basis as follow-up to consultations they completed.
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The Moyne Nursing Home, The Moyne, Enniscorthy, Wexford

The Moyne Nursing Home, The Moyne, Enniscorthy, Wexford

There was evidence to support that residents’ healthcare requirements were adequately and regularly assessed by competent nursing staff and that arrangements were in place to meet assessed needs. On admission residents were facilitated to retain access to their general practitioner (GP) of preference. There was documentary evidence that residents, as appropriate to their needs, had access to other healthcare professionals and services including dietetics, speech and language therapy, occupational therapy, psychiatry, chiropody and physiotherapy. Further arrangements were in place to facilitate optical and dental review. The inspector saw that each resident had a nursing plan of care and noted that they were prepared within 48 hours of admission into the center, as required by regulation. Staff to whom inspectors spoke with were knowledgeable of residents' health and social care needs.
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The Moyne Nursing Home, OSV 0004373, 13 June 2018

The Moyne Nursing Home, OSV 0004373, 13 June 2018

arrangements to ensure safe and suitable care for residents. For example, as part of a structured care quality initiative; the assistant director of nursing was working alongside individual healthcare assistants for defined periods to support them in their clinical competency development and practice in order to improve the delivery of care to residents. There had also been a review of the admissions policy to ensure all potential residents needs including residents with a dementia, could be suitably met, taking into consideration the residents already living within the centre. There were processes in place to ensure that when residents were admitted, transferred or discharged to and from the centre, relevant and appropriate information about their care and treatment was available and maintained, and shared between providers and services. In relation to admissions to any shared bedroom, the person in charge outlined how each prospective resident was assessed prior to any such admission to inform the suitability/compatibility of such admission. In addition, a care plan audits had most recently been completed in January 2018 and the findings from this review informed discussions with staff and governance management team meetings. The inspector noted that following these meetings corrective actions were taken including further care practice audits and on- going changes to the care planning documentation. The person in charge also outlined additional enhanced clinical governance and oversight in the centre. For example, all residents with dementia and/or their representatives had completed questionnaires that informed staff as to their choices and preferences for end of life care. There had been an audit of meals and meal times which resulted in improvements and changes to the menu and an improved dining experience for residents, including residents with dementia.
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The Moyne Nursing Home, The Moyne, Enniscorthy, Wexford

The Moyne Nursing Home, The Moyne, Enniscorthy, Wexford

On this inspection inspectors formed the judgement through observation, speaking with staff and review of documentation that there was an adequate complement of nursing and care staff with the required skills and experience to meet the assessed needs of residents taking account of the purpose and size of the designated centre. Staff told the inspector that they were well supported by the management team and that there was adequate staff deployed to meet the needs of residents. A relative who spoke with the inspector said that there was enough staff on duty.

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phlp_entire.doc

phlp_entire.doc

decisions rely on nursing assessments. Fleet’s intervention changed prescribing practices by focusing on nurses rather than prescribers. It was associated with a 5% overall reduction of antibiotic prescriptions in intervention homes. Interventions that included prescribers and nurses were common. Five studies (Loeb, Pettersson, van Buul, Zabarsky, and Zimmmerman) specifically provided educational sessions for the recommended management of common bacterial infections for the NH. These multidisciplinary interventions led to reductions in prescriptions compared to their previous performance in other NHs. Zimmerman coordinated a quality improvement initiative with the studied ASP to educate physicians, nurses, residents and their families on the role of antibiotic stewardship. NH caregivers often identify the families as driving forces for prescribing antibiotics. 58 Zimmerman’s results indicate that including these
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Factors associated with high job satisfaction among care workers in Swiss nursing homes – a cross sectional survey study

Factors associated with high job satisfaction among care workers in Swiss nursing homes – a cross sectional survey study

Overall, nursing home care workers with diverse edu- cational backgrounds report moderate to high job satis- faction [15–18]. In the U.S., data from the 2004 National Nursing Home Survey indicated that 82 % of nursing assistants were satisfied or extremely satisfied with their jobs [19]; in Sweden, 76 % of nursing assis- tants reported moderate or high general job satisfaction [20]. In a recent concept analysis, job satisfaction was de- fined as “an affective reaction to a job that results from the incumbent’s comparison of actual outcomes with those that are desired, expected and deserved” (p 130) [21]. Accord- ingly, the complex phenomenon of nurses’ job satisfaction depends upon their sense of personal accomplishment, their personal expectations, and the nature of their jobs [12]. Along with broad differences in these variables among care workers, methodological differences in meas- uring them can lead to broad variations in care workers’ job satisfaction and its antecedents, not only between countries but also between settings and professional groups. A recent review compared results concerning per- sonal and organizational antecedents of job satisfaction between nurses in hospitals and care aides in residential long-term care [14]. In the latter group, observed varia- tions included a higher valuation of workload and lower valuation of coworker support regarding job satisfaction. Although the question remains open whether this reflects differences in educational backgrounds or in settings, it shows that desired, expected or deserved outcomes vary considerably among healthcare professionals, and that a context-specific approach is needed to identify relevant antecedents.
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State Variation in Posthospital Home Nursing for Commercially Insured Medically Complex Children

State Variation in Posthospital Home Nursing for Commercially Insured Medically Complex Children

In the unadjusted bivariate analysis (Table 1) receipt of home nursing was associated with patient age, patient sex, year, admission type (surgical versus medical), each additional hospital day, having . 1 CCC, and most CCC types ( P , .001). In the multivariable adjusted analysis (Table 1), the same associations were identi fi ed. The addition of state of residence improved model fit significantly (likelihood ratio test, P , .001). Across states with an adequate sample size, the average adjusted marginal probability of receiving any posthospital home nursing across the states of residence ranged from 3.4% to 19.2% (Fig 1, Supplemental Table 3).
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Adjustment of nursing home quality indicators

Adjustment of nursing home quality indicators

There are two main approaches to risk adjustment of nursing home QIs: stratification and indirect standard- ization. A third, multilevel modelling, has not yet migrated from academic to applied settings [12]. Stratifi- cation involves identification of discrete risk groups and computing QIs separately within each group (strata). Strengths of this approach include transparency and computational simplicity. Disadvantages include coarse- ness of adjustment. Coarse adjustment may result in residual confounding, the problem that differences across facilities may exist within broadly defined strata. Stratifi- cation also leads to QIs with small denominators, exacer- bating issues of measurement precision and stability when event rates are low. Stratification was advocated by one of the first major operational systems of nursing home QIs [3,13]. Throughout this manuscript we refer to this approach as the first generation approach to QI scor- ing.
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Patterns of multimorbidity in an ageing population of people with an intellectual disability: Results from the intellectual disability supplement to the Irish longitudinal study on ageing (IDS TILDA)

Patterns of multimorbidity in an ageing population of people with an intellectual disability: Results from the intellectual disability supplement to the Irish longitudinal study on ageing (IDS TILDA)

Background: Undesirable outcomes in late life are often a result of declines in social engagement and inadequate nutritional intake. To target these two issues simultaneously, we present the RelAte project, a relationship-based mealtime intervention study. Previous research has shown that similar interventions can benefit the physical [1] and social [2] wellbeing of older nursing home residents. We aim to deliver our intervention to community-dwelling, independent older adults. Methods: 100 individuals who are identified as being at risk of social isolation will be recruited to the study. 50 participants will be randomised to the treatment group, and 50 to the control group. Peer volunteers will also be recruited and trained to deliver the mealtime intervention in the homes of the intervention group participants, once weekly for 8 weeks. Psychological, cognitive, and health-related metrics will be assessed at baseline, post-intervention and at two follow-up points to investigate whether an intervention of this type can be seen to have a statistically significant impact on quality of life and psychosocial wellbeing in socially isolated older adults. Another area of interest to the researchers is the impact of the intervention on the peer volunteers; this will be inves- tigated also using relevant psychometric assessments post-intervention. Results: We report relevant guiding principles from the literature. These principles include person-centred care, relevant nutritional guidelines for the clinical population, and prior research on rela- tionship-based interventions. Our goals include the successful enhancement of the quality of life of socially isolated older adults, by providing them with two combined services within their own home. We outline our plans to deploy the RelAte intervention in the homes of 50 individuals in the community.
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Acute hospital admissions among nursing home residents: a population based observational study

Acute hospital admissions among nursing home residents: a population based observational study

We studied acute hospital admission rates among elderly people (age ≥ 67) in the Municipality of Bergen, Norway, a geographically well-defined area, from 1 st January 2007 to 31 st December 2008. The data were ascertained by retrospectively linking several databases with electronically coded data. We identified all cases through the Acute Medical Information System (AMIS) through the Bergen Hospital Trust under the Western Norway Regional Health Authority. There are two local hospitals in the health trust. The cases stemming from nursing homes were identified through ambulance records and investigated further. Specifically we investi- gated the hospital stays of the NHP for diagnosis at dis- charge, length of stay and mortality. This information was extracted electronically from hospital patient records corresponding to the personal identification number on the ambulance record and time of transfer (Figure 1). We did not include elective hospital admis- sions or admissions from lower levels of residential facil- ities, identified by defining the search by this criterion in AMIS.
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Norwegian Nursing Home—A Care Facility or a Home?

Norwegian Nursing Home—A Care Facility or a Home?

A study of drug utilisation quality amongst more than 1500 residents in Norwegian nursing homes revealed that the majority of the residents were at risk of side effects, insufficient use, or they were under medicated [15]. The findings are further supported by a study of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes showing that the prevalence of inadequate use of antipsy- chotic medicine amongst residents with a dementia disease and aggressive behaviour was particularly high [16]. A survey study (n = 616) of inadequate care, abuse and neglect in Norwegian nursing homes [17] revealed that nursing home residents to a great extent are exposed to abuse and neglect from staff.
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Dermatological and musculoskeletal disorders of nursing home workers in Australia, Japan, South Korea and Taiwan

Dermatological and musculoskeletal disorders of nursing home workers in Australia, Japan, South Korea and Taiwan

Skin diseases among Australian nursing home staff ……………………… Page 44 Skin diseases among Japanese nursing home staff ……………………… Page 59 Skin diseases among South Korean nursing home staff ….………..……… Page 72 Skin diseases among Taiwanese nursing home staff ……………………… Page 91 Skin diseases comparisons (Part 1) ……..………………………………….. Page 107 Skin diseases comparisons (Part 2) .....…….……………………………….. Page 118

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The History and Memory of the Assassination of Lord Moyne

The History and Memory of the Assassination of Lord Moyne

The sharpest contrast lies between the British paper and the Israeli papers. In Israel the eulogies and speeches that surrounded Shamir’s funeral were used to promote the image of the seventh prime minister as a foundation to the state of Israel. One report says “Knesset speaker Reuven Rivlin stated ‘you’ve carried the weight of this nation, its past and future, on your shoulders.’” 99 In addition, the Times of Israel’s article “Yitzhak Shamir laid to rest at Mount Herzl” remembers Shamir as a fighter for Israel and does not mention the assassination of Lord Moyne. Yitzhak Shamir has been remembered as simply the seventh prime minister of Israel but that has been rare in his obituaries and eulogies. More often than not, the memory of Lord Moyne’s assassination has been used to define Yitzhak Shamir. The memory of Lord Moyne has been a constant in Shamir’s life as evidenced by his own writing and interviews. In 1975, Shamir was the one who looked upon the bodies of the assassins, identified them and collected their remains. 100 With Shamir’s passing, people have still tried to use this specific memory to either vilify or canonize him. Tracing from 1944, when the assassination took place to Yitzhak
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Dermatological and musculoskeletal disorders of nursing home workers in Australia, Japan, South Korea and Taiwan

Dermatological and musculoskeletal disorders of nursing home workers in Australia, Japan, South Korea and Taiwan

This thesis documents a 4-year investigation of skin disease and musculoskeletal disorders conducted among 465 nursing home staff in Australia, Japan, South Korea and Taiwan. Skin diseases were diagnosed by specialist physicians during medical examinations, while information on musculoskeletal disorders was collected by means of a self-reported questionnaire. There were major differences in both the location and type of skin disease between the 4 groups. Overall, the Australian group suffered a generally higher prevalence of skin disease than in the other three countries investigated, most likely due to their significantly higher rate of sun-induced skin damage. The high prevalence of cutaneous fungal disease seen within the Taiwanese subjects most probably arose from the comparatively higher temperature and relative humidity of Taiwan. Other potentially important skin disease risk factors included previous skin disease and a history of allergy, both of which are consistent with current knowledge. Although musculoskeletal disorders were found to be most prevalent among the Japanese nursing home staff at almost all body sites, the reasons for this are not clear. It may have related to a generally higher musculoskeletal rate, or a higher degree of self-reporting on their questionnaires. Individual MSD risk factors included moving patients, washing patients, working as an assistant nurse and daily alcohol consumption. Interestingly, MSD was found to be a co-factor for current skin disease.
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End-of-life care communications and shared decision-making in Norwegian nursing homes - experiences and perspectives of patients and relatives

End-of-life care communications and shared decision-making in Norwegian nursing homes - experiences and perspectives of patients and relatives

An earlier study of end-of-life decisions in Norwegian nursing homes found that doctors very seldom involved patients in end-of-life care decisions, but instead con- sulted the next-of-kin [52], even though the patient was still competent. This is not in accordance with laws and guidelines. There may be different reasons not to involve the patient in plans and decisions for end-of-life care, in- cluding time constraints of the health professionals, a lack of confidence in initiating and leading such conver- sations, fear of upsetting the patient or the fact that pa- tient’s preferences might change. Patient predictions of preferences and reactions to hypothetical future events are both inaccurate and unstable over time [53]. That is, involving patients in plans and decision for end-of-life care is not a onetime effort, but has to be a continuous process that adapts to the patient’s condition and needs.
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A PEDIATRIC HOME CARE PROGRAM IN LONDON—TEN YEARS EXPERIENCE

A PEDIATRIC HOME CARE PROGRAM IN LONDON—TEN YEARS EXPERIENCE

As distinct from home nursing services, another type of home care consists of an extension of hospital work into the home of the patient.. The leading advocate of..[r]

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Food assistance is associated with decreased nursing home admissions for Maryland’s dually eligible older adults

Food assistance is associated with decreased nursing home admissions for Maryland’s dually eligible older adults

nursing home placement while adjusting for income. This study is strengthened by time lagged measurement of SNAP spending, which ensures that receipt of SNAP bene- fits temporally precedes nursing home use. Another strength of the study is that we examine the entire popula- tion of interest in one state with objective measurement of SNAP receipt rather than self-report. A final strength is the ability to look at “dose” of SNAP in $10 increment. In our analyses, those with higher benefits (but same income) are less likely to be admitted to a nursing home and/or have shorter nursing home stays. Since prior work has focused on the SNAP enrollment effect, our results contribute to the literature by demonstrating a dose-response association between benefit amounts and nursing home stays.
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Adjustment of nursing home quality indicators

Adjustment of nursing home quality indicators

Finally, it is important to note that some limitations of QI scoring in first and second generation frameworks remain in our proposed third generation framework. Par- ticularly, the third generation framework does not directly address the problem of low base rates (rare events). More work is needed to address this issue. One approach would be to accumulate observations over a long period of time. Typically nursing home QIs are scored quarterly, but longer periods may allow the accu- mulation of more events and lead to more stable esti- mates. The cost of such an approach is the greater time lag may not capture current quality or care practices at a given facility. A better approach may be to limit consider- ation of viable QIs to those that do not have a low base rate.
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The treatment of hypertension in care home residents: a systematic review of observational studies

The treatment of hypertension in care home residents: a systematic review of observational studies

unexpected, as most guidance no longer recommends them for the treatment of hypertension and favors the use of calcium channel blockers. This could be an example of a treatment lag in this po- pulation, or that other factors, such as heart failure, are acting as confounders. However, treatment rates for hypertension in care home populations were higher than in noncare home hypertensive populations (70% vs 63%), 27 which does not support the hypothesis that the treatment of this long-term condition is overlooked in care home residents.

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