Future Tense:
1) The purpose of this intro – how will it help you? How will it help the reader? How will it differ from other sections of your overall project?
The purpose of this introduction is to inform the reader about what information the paper will cover. It will help me as the writer because it will outline what information I need to cover to develop an informed reader/ audience. It will help the reader by informing the reader of what will be covered in the paper and what they can expect.
2) Your goals for this paper – what do you hope to/will you accomplish by the end of this paper? I hope to inform my audience of what an assisted living is, who works at assisted livings, present research preformed in assisted livings, and my personal experience working as a caregiver in an Assisted Living Facility.
3) Your target audience – who is this prepared for? Who do you hope will read this? How will you tailor your writing for this audience? See why it’s good to have some sense of where you might publish? I hope that a medical journal like Journal of Research in Nursing will be able to read this a possibly publish this research paper. The Journal of Research in Nursing has published Auto ethnographies by nurses. I will write my paper in APA format and also format it in a way that reflects Jane Wright’s Nursing Autoethnography that was published.
Higher Educated Caregivers: Cutting Cost and
Increasing Care in Assisted Living Facilities
Andrea Chandler
Research Writing
Marlen Harrison
March 2, 2010
Introduction
“Staff working on-site, providing 24-hour coverage should be sufficient in numbers and experience to meet the ongoing needs of the residents. Staff should be knowledgeable about basic changes in aging, aging drug pharmacology, falls prevention, incontinence care, ADL skills, communication techniques, dementia care, and recognition of acute illness/delirium. In addition, staffing levels and expertise should be discussed with all potential ALF residents to assist in the initial choice of ALF. To provide the most effective care, staff working daily with persons requiring assistance should have a working knowledge of normal aging and common problems seen in aging. Staff must be able to assist persons in such a way that whatever residual independent capabilities the residents are not lost through learned helplessness. Also, staff must be able to discern when significant changes have occurred that require evaluation by qualified professionals (Stefanacci, RG, & Podrazik, PM., 2005). In a perfect system ALF would be able to have educated caregivers that would be able to assist the resident in all of the above. But what happens when you have an inexperienced staff in your facility? Does an LPN who just recently graduated from their licensing program have the expertise to differentiate between appropriate and inappropriate care? How does the increase staffing of higher educated caregiver’s, not only affect the quality of the patient care, but also increase knowledgeable patient care and decrease cost for the ALF resident?
“Back in the mid-1990s, assisted living trade organizations proposed best practices and risk-limiting protocols for the industry. The guidelines covered four main areas: services, environment, consumer protections (including resident rights, contracts, and risk negotiation), and management responsibilities. These still serve as the basis for risk-management protocols in the current assisted living environment” (Peterson, S. 2005). Even with the use of these protocols by Assisted Living facilities, the staffing of long term care facilities have gone under scrutiny for the quality of care that they give their residents. “Recent studies have demonstrated that there is a clear link between quality and staffing in acute and long-term care settings(Abt Associates, 2001; Aiken, Clarke, Sloane, Sochalski, & Silver, 2002; Eaton, 2000; Weech-Maldonado, Meret-Hanke, Neff, & Mor, 2004),yet nursing homes fall far below the staffing levels indicated by the quality studies (Abt Associates, 2001). High nurse staffing turnover contributes to the nursing shortages and high labor costs of nursing homes” (Weech-Maldonado, R, Shea, D, & Elmendorf, K., 2007). This link can also be shown in Assisted Living Facilities (ALF) as demonstrated in a study by Castle, N.G., & Engberg, J. in 2007 that states, “Quality of care was influenced, to some degree, by all of these staffing characteristics. However, the estimated interaction effects indicated that achieving higher quality was dependent on having more than one favorable staffing characteristic—the effect of quality was larger than the sum of the independent effects of each favorable staffing characteristic.” “For RNs, staffing levels are also important, with low staffing associated with lower quality; whereas, for NAs [nursing assistants], stability is also important, with low stability associated with lower quality” (Castle, N.G., & Engberg, J., 2007). In other words, staffing of both the registered nurses on staff and the nursing assistants must be favorable for the employee in order to have high quality in Alf’s.
Much research has been done to show the link between the increase staffing of ALF and the quality of the care given in the facility. One way to bring new and informative data into this research is through the use of Auto ethnography. Jane Wright suggests, “That by researching ourselves we can learn how our beliefs, attitudes and values about health, illness and care have been constructed. We can perhaps imagine how others have developed theirs and appreciate that others perspectives may be as valid as our own.” (Wright, J., 2008) “Charmaz (2006), in an issue of the Journal of Contemporary Ethnography devoted entirely to auto ethnography, states more simply that auto ethnography [is] concentrated on the researcher’s own previous or present experience(As quoted from Wright 2008 p. 338).” By writing about personal experience, an author can inform their readers of what they have experienced. By using my personal experience working as a direct/mobile caregiver, I can give a first hand account of what it is like to work in ALF and what problems I have seen. This will contribute to the medical field by giving insight into the problems that continue to need revised in the ALF protocols.
References
Castle, N.G., & Engberg, J. (2007). The influence of staffing characteristics on quality of care in nursing homes. Health Services Research, Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2254574/ doi: 10.1111/j.1475-6773.2007.00704.x.
Peterson, S. (2005). Developing risk-management protocols in assisted living: assisted living has its own litigation traps for the unwary. Nursing Homes: Long Term Care Management , 54(11), Retrieved from http://web.ebscohost.com /ehost/detail?vid=3&hid=11&sid=73e293b6-662d-40bd-9644a9cf3e63eaa3% 40sessionmgr13&bdata=JnNpdGU 9ZWhvc3QtbGl2ZQ%3d%3d#db =c8h&AN=2009095383
Stefanacci, RG, & Podrazik, PM. (2005). Assisted living facilities: optimizing outcomes.. Journal of the American Geriatrics Society, 53(3), Retrieved from http://web.ebscohost.com/ehost/detail?vid=5&hid=11&sid=73e293b6-662d-40bd-9644-a9cf3e63eaa3%40sessionmgr13&bdata= JnNpdGU9ZWhv c3QtbGl2Z Q%3d%3d#db=c8h&AN=2005076192#db=c8h&AN=2005076192
Weech-Maldonado, R, Shea, D, & Elmendorf, K. (2007). Long-term care providers and their perceptions of the external environment: rural versus urban differences. Journal of Applied Gerontology, 26(78), Retrieved from http://jag.sagepub.com/cgi/reprint/26/1/78 doi: 10.1177/0733464806296145
Wright, J. (2008). Searching one’s self: the autoethnography of a nurse teacher. Journal of Research in Nursing, 13(4), Retrieved from http://jrn.sagepub.com/cgi/ reprint/13/4/338doi: 10.1177/1744987107088046
After Writing:
This intro will inform my readers of what standards of care are in ALF. Also it will cover current research and ideas presented by medical researchers. They will know the importance of Autoethnography, it’s uses, and how I will be using it as an author. By including all this information I will create informed readers which is my goal and I accomplished all I set out to do.
