Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
J Am Med Dir Assoc. 2010 Sep;11(7):494-9. doi: 10.1016/j.jamda.2010.01.006. Epub 2010 Aug 1.
Staff communication has been shown to influence overall nursing home (NH) performance. However, no empirical studies have focused specifically on the impact of CNA communication on end-of-life (EOL) care processes. This study examines the relationship between CNA communication and nursing home performance in EOL care processes.
Secondary data analysis of 2 NH surveys conducted in 2006-2007.
One hundred seven nursing homes in New York State.
Participants were 2636 CNAs and 107 directors of nursing (DON).
The measures of EOL care processes-EOL assessment and care delivery (5-point Likert scale scores)-were obtained from survey responses provided by 107 DONs. The measure of CNA communication was derived from survey responses obtained from 2636 CNAs. Other independent variables included staff education, hospice use intensity, staffing ratio, staff-resident ethnic overlap index, facility religious affiliation, and ownership.
The reliability and validity of the measures of EOL care processes and CNA communication were tested in the current study sample. Multivariate linear regression models with probability weights were used. The analysis was conducted at the facility level.
We found better CNA communication to be significantly associated with better EOL assessment (P = .043) and care delivery (P = .098). Two potentially modifiable factors-staff education and hospice use intensity-were associated with NHs' performance in EOL care processes. Facilities with greater ethnic overlap between staff and residents demonstrated better EOL assessment (P = .051) and care delivery scores (P = .029).
Better CNA communication was associated with better performance in EOL care processes. Our findings provide specific insights for NH leaders striving to improve EOL care processes and ultimately the quality of care for dying residents.
已有研究表明，员工间的交流能影响养老院的整体表现。然而，目前还没有专门针对护理员交流对临终关怀流程影响的实证研究。本研究旨在探讨护理员交流与临终关怀流程中养老院表现的关系。
对 2006-2007 年进行的两项养老院调查的二次数据分析。
纽约州的 107 家养老院。
2636 名护理员和 107 名护理主任。
临终关怀流程的测量指标——临终评估和护理提供（5 分李克特量表评分）——由 107 名护理主任的调查答复得出。护理员交流的测量指标来源于对 2636 名护理员的调查答复。其他的独立变量包括员工教育程度、临终关怀使用强度、人员配备比例、员工-居民种族重叠指数、机构宗教隶属关系和所有权。
在本研究样本中，对临终关怀流程和护理员交流的测量指标的信度和效度进行了测试。采用带有概率权重的多元线性回归模型。分析在机构层面进行。
我们发现，更好的护理员交流与更好的临终评估（P =.043）和护理提供（P =.098）显著相关。两个潜在的可改变因素——员工教育程度和临终关怀使用强度——与养老院临终关怀流程的表现相关。员工与居民之间的种族重叠程度越大，临终评估（P =.051）和护理提供评分（P =.029）越好。
更好的护理员交流与临终关怀流程的更好表现相关。我们的研究结果为努力改善临终关怀流程并最终提高临终居民护理质量的养老院管理者提供了具体的见解。
