Purpose: This study identified how unlicensed staff members decide to administer medications prescribed pro re nata (PRN) to residents of assisted living (AL) settings designated for persons with dementia. Theories of knowledge, including explicit and implicit knowledge, discretion, and judgment, guided the analysis. Design and Methods: Data were…

Purpose: The Resident Assessment Instrument-Minimum Data Set (RAI/MDS) is an interdisciplinary standardized process that informs care plan development in nursing homes. This standardized process has failed to consistently result in individualized care planning, which may suggest problems with content and planning integrity. We examined the…

Purpose: This study's purpose was to advance the process of culture change within long-term care (LTC) and assisted living settings by using participatory action research (PAR) to promote residents' competence and nourish the culture change process with the active engagement and leadership of residents. Design and Methods: Seven unit-specific PAR…

Purpose: To identify differences in perspectives that may complicate the process of joint decision making at the end of life, this study determined the agreement of family and staff perspectives about end-of-life experiences in nursing homes and residential care/assisted living communities and whether family and staff roles, involvement in care,…

The ethical primacy of patient involvement in treatment decision-making requires that more attention be paid to assessment of a patient's competency to make treatment decisions. Makes recommendations to increase sensitivity to this issue with significantly impaired elderly nursing home patients and to improve existing decision-making procedures.…

Surveyed nursing homes in New York in 1986 and 1988 concerning policies on decisions about life-sustaining treatment, patient decision-making capacity, prevalence of ethics committees to resolve disputes, and advance directives. Between 1986 and 1988, number of facilities with explicit policies and institutional vehicles to address issues…

Purpose: Advance directives are important planning and decision-making tools for individuals in nursing homes. Design and Methods: By using the nursing facility Minimum Data Set, we examined the prevalence of advance directives at admission and 12 months post-admission. Results: The prevalence of having any advance directive at admission declined…

Assessed decision-making capability and preferences regarding advance directives of 39 nursing home residents and proxies. Most patients willingly stated preferences; over one-half opted to forego burdensome measures when death appeared imminent. Decisionally capable patients were more likely to forego life-sustaining measures than those of…

Interviewed 198 nursing home residents and 34 primary nurse caregivers regarding perceptions and preferences of resident participation in health care decisions. Approximately 40 percent of residents reported being told nothing about their medical conditions; another 40 percent reported being told everything. Concordance between residents' and…

Commissioned scholarly papers and undertook anthropologic observation to examine legal and ethical issues for patients, family, and caregivers during discharge planning. Proposed policy suggestions in which conflicting interests were recognized but in which patients' rights to autonomous decision making in discharge planning were strongly…

Examined attitudes of elderly acute-care hospital patients (N=264) concerning discharge planning. Respondents varied in their reactions to discharge planning and degree to which they exerted final control over decision. Perceived lack of control was associated with posthospital psychological distress for patients with high levels of internal locus…

Examines the unique, combined, and interactive contribution of existential variables and traditional measures as predictors of depression in institutionalized and community-residing older adults. Results show that choice-responsibleness, social resources, and physical health predicted depression in community elderly; personal meaning, optimism,…

Examined placement of 248 older mentally ill persons into independent settings, community-based programs, or level III or level IV nursing homes. Risk of institutionalization increased as cognitive skills and family support declined. Consistent predictor of placement was prior residence. Number of medical problems and need for nursing or…

Conducted longitudinal study of 196 caregiver/care receiver dyads to determine variables predictive of caregiver decision to institutionalize dependent with dementia. Use of services, enjoyment of caregiving, caregiver burden and health, caregiver rating and reaction to care receiver behavior and memory problems, and presence of troublesome…

Monitored room changes in four nursing homes over one-year period. Used participant observation; repeated interviews with residents, family members, and nursing home staff; and event analyses to develop detailed case studies of room change decision-making process. Resulting model of room change process and factors influencing process involved five…