College of Health Professions

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A Profile of Nursing Assistants Employed in Central Texas Nursing Homes
(1994-12) Ransom, Sandy; Fox, Nancy
No abstract prepared.
An Analysis of a Statewide Survey and the Assessment of Needs within the Long Term Care Delivery System in the State of Texas
(1995-09) Upchurch, Marian; Knox, Beth
This needs assessment study addressed the needs of various components of the nursing home industry in Texas - those involved in management of long term care facilities, those involved in direct care of long tern care residents, owners of long term care facilities, those involved in regulatory aspects of long term care, and those involved consumers - direct and indirect - of services in long term care facilities. The assessment addressed structural, process, and educational needs of nursing homes. Ten key items were identified via several pretests and utilized in the final survey through a closed format Lilcert-type instrument and a narrative component which also allowed for an open-ended expression of ideas or concerns. The ten key items utilized in the final survey were: (1) Management training for all supervisors, (2) More geriatric nursing skills, (3) Increased physician involvement, (4) Greater consistency in the survey process, (5) Requirement for improved nurse aide to resident ratio, (6) More sensitivity by staff to resident needs, (7) Improvement in food quality and the dining environment, (8) Greater family involvement, (9) More homelike environment, and (10) More educational requirements in long term care for initial licensure as a nursing home administrator. Subjects were asked to rank these ten key items as well as to indicate how much should be done to address each item. In addition to the ten items included in the instrument, subjects were also given an opportunity to identify one additional specific concern in long term care. These comments were assembled and presented in the final report. Respondents gave an overall rating to the quality of care in nursing homes at 5.37 on a ten point scale. Consumers ranked care with a low of 2.6, while administrators recorded the highest rating of 6.8. The highest priority ranked item by the survey respondents was more sensitivity by staff to resident needs. The highest priority items were also grouped as structural, process, and educational needs, and analyzed with the following results. The structural item ranked highest in importance by the survey group was the requirement for improved nurse aide to resident ratio. The highest priority ranked process item was more sensitivity by staff to resident needs. Two educational needs emerged with highest priority rankings: the highest ranked was that of more geriatric nursing skills. Management training for all supervisors was ranked slightly lower. When the importance of the ranking of the ten items was contrasted with the desire to take action on each of the ten items, these same items appeared as the major four items to be addressed. The results varied when the rankings of the ten key items were analyzed by region of Texas or by position of the respondent. Consumers, regulators, and directors of nurses agreed that the highest priority of concern was the requirement for improved nurse aide to resident ratio. Owners and administrators believed the highest priority issue to be greater consistency in the survey process. An analysis of the highest ranked issues by region of Texas indicated that the east and west regions agreed that the highest ranked item was more geriatric nursing skills; central and south regions of Texas rated more sensitivity by staff to resident needs at the top rank; and the metropolitan areas of Texas indicated the requirement for improved nurse aide to resident ratio as the highest ranked item.
The Effect of Validation Therapy Training On Satisfaction with Communication and Quality of Relationship Between Staff and Family Caregivers and Demented Residents in Long Term Care
(1995-09) Canon, Robert L.
The effect of Validation Therapy training on satisfaction with communication and quality of relationship for caregivers of dementia patients was evaluated in a quasi-experimental design. Subjects were recruited from primary family and staff care givers of dementia patients at 5 central Texas long term care facilities. Training was provided by Naomi Feil at her biennial workshops utilizing a multimedia approach with didactic and experiential components. Quality of relationship was measured by the Dementia Caregiver Quality of Relationship Inventory, an instrument developed by the author, while the Interpersonal Communication Satisfaction Inventory (Hecht, 1978) measured care giver satisfaction with dyadic interaction. A test incorporating several instruments developed by Feil (1992) was used to assess validation skills. Demographic and descriptive variables were also collected. Bivariate analysis indicated a significant increase in communication satisfaction for dementia caregivers who received Validation Therapy training when compared to a group of caregivers who received no training. Although there were no differences between family and staff on change in satisfaction level with Validation Therapy training, staff caregivers were significantly more satisfied with communication at both pre-test and post-test. No experimental or caregiver group status effect on quality of relationship was observed. The Validation Therapy skills instrument demonstrated unacceptably low reliability and were excluded from analysis. Discussion of the psychometric properties of these instruments and the need for reliable measures to assess the effect of Validation Therapy training and practice is provided.
The Impact of a Unit Clerk on Nurse Effectiveness in A Texas Long Term Care Facility
(1996-02) Ransom, Sandy
Funding was provided by the Institute for Quality Improvement in Long Term Health Care for placement of a ward clerk at a busy nursing unit in a Texas nursing home. The purpose of funding the study was to establish a demonstration study to determine if the placement of the ward clerk would effectively reduce the amount of time the charge nurse was required to allocate to various forms of paperwork. Staff/resident ratios are frequently below optimum in Texas nursing homes. Nursing task time dedicated to compliance with corporate, state, and federal regulations is time that detracts, appreciably, from resident care. Detailed logs kept of nursing activities prior to placement of the ward clerk and after six months of the clerk's employment were compared for differences in utilization of time for the charge nurse. Types and frequencies of resident incidents were compared for the six-month time periods before and after the ward clerk was hired. Comparison of figures revealed that the charge nurse was actually able to spend 62% more time with the residents and 60% more time involved with staff supervision than previously. A decrease in 28.6% of charting time was realized, as well as a 42% reduction in the amount of time the charge nurse was involved with phone calls. An overall reduction of 48.5% of total incidents was achieved during the period of time under study.
Education in Gerontology in Texas Schools of Social Work
(1996-02) Murray, Yvette
Will the supply of social workers trained in gerontology meet the increasing demand for social services from the elderly population? The research study evaluates the present situation concerning formal education in gerontology in Texas schools of social work. Questionnaires were mailed to all accredited undergraduate and graduate programs, plus three new, nonaccredited graduate programs. Follow up telephone calls produced a 100% response rate from the research population. The results of the survey indicated that the majority of undergraduate programs use field settings involving the elderly, but less than half of these programs offer specific courses in aging. All accredited graduate programs have courses and field practicums in aging; however, only one program offers a specialization for advanced study in gerontology. None of the new graduate programs have courses or specializations in aging. When social work students do enter field internships in agencies which serve the elderly, they generally do not receive stipends. Of the of 25 undergraduate and seven graduate programs surveyed, only one social work program had more than one stipend available annually.
Training Needs of Social Workers in Texas Nursing Homes
(1996-06) Murray, Yvette
What is the level of professional training and experience of staff presently in social work positions in Texas nursing facilities? Is there a need for continuing education in gerontology for nursing home social workers? These questions were the focus of a statewide survey of 1,137 nursing homes. Forty-three percent of these facilities responded to a mail questionnaire. Results of the data analysis revealed that the median for employment in the nursing home was 1.5 years, with over half of the respondents lacking any additional work experience in aging. Over one-third of the respondents did not have a social work degree, and 60% had not taken a course in gerontology. In addition, 80% of the graduate and undergraduate social workers had not completed an internship in aging. Only 3% of the social workers were licensed as Advanced Clinical Practitioners. The majority of the respondents, 90%, stated their intention to continue practicing in long term care. The top three needs identified in continuing education were developing psychosocial assessments, dealing with dementia, and treating depression. The research findings have generated questions involving the regulation of social work practice in Texas nursing homes, as well as issues concerning social work education in gerontology. Furthermore, the research results have demonstrated the need for continuing education for social workers currently practicing in long term care facilities.
Guidelines for Nursing Home Social Workers
(1996-06) McNeil, John S.
No abstract prepared.
World of Wisdom, Age of Innocence: an Intergenerational Exchange Program
(1996-11) Renick, Oren; Barber, Anastasia; Ermis, Ellen V.; Williams, Sue; Blunk, Elizabeth
An interdisciplinary team from Southwest Texas State University implemented an intergenerational exchange program between residents at a local nursing home and preschool children from the University's child care program. The study was undertaken to study and evaluate the impact of intergenerational relations on the quality of life of nursing home residents, quality of care of nursing home residents, and perceptions of preschool children on the elderly and aging. Program development, implementation and outcomes are discussed with implications for replication by others.
Molecular Epidemiology of Rabies Epizootics in Texas
(Elsevier, 1997-04) Rohde, Rodney E.; Neill, Susan U.; Clark, Keith A.; Smith, Jean S.
Background: Texas is in the midst of two independent epizootics of rabies, involving coyotes (Canis latrans) and domestic dogs (Canis familiaris) in southern Texas and grey foxes (Urocyon cinereoargenteus) in west central Texas. The domestic dog/coyote (DDC) and grey fox (TF) rabies virus variants cannot be differentiated by antigenic typing with currently available monoclonal antibodies. These two variants also cannot be distinguished from a third variant, Sonora dog (SD) rabies, that is not enzootic in Texas, but occasionally occurs in animals along the western border with Mexico. Objectives: To determine a method for the differentiation of the DDC, TF and SD variants, which is essential for epidemiologic monitoring of the Oral Rabies Vaccination Program (ORVP), a program instituted to control rabies in coyotes and grey foxes in Texas. Study Design: Primers complimentary to nucleoprotein sequence of either the DDC or TF rabies virus permit specific reverse transcription and amplification by polymerase chain reaction. In addition, general primers, which recognize a broad range of rabies variants, used in conjunction with a restriction digest for the differentiation of DDC, TF or SD rabies virus were investigated. Results and Conclusions: Of 122 specimens tested with specific primers, 111 (91%) were specifically identified as either DDC (33 samples) or TF (78 samples). Overly stringent conditions, enzyme inhibitors, or limiting RNA may account for the 11 non-amplifications. Amplification of RNA under less stringent conditions, with primers recognizing a broad range of rabies variants followed by digestion with either restriction enzyme Desulfovibrio desulfuricans I (DdeI) or Haemophilus influenzae Rf. (HinfI), was used to identify the 11 isolates that did not amplify with specific primers (6 DDC, 4 TF and 1 SD). In addition to these 11 isolates, the less stringent method of amplification, followed by enzyme digestion has identified a total of 125 additional specimens (26 DDC, 94 TF and 5 SD) that were not tested by variant-specific amplification. These data provide a means to track the spread of the different rabies virus variants and allow the ORVP to plan its vaccine disbursement by defining the two epizootic boundaries.
Evaluation of the Effectiveness of a Computer Based Communication System in Enahncing the Communicative Abilities of Individuals with Severe Aphasia
(1997-06) Koul, Rajinder
One of the most significant recent advances in improving the communicative abilities of individuals with chronic severe aphasia has been the development of augmentative and alternative communication (MC) methods; that is techniques, strategies, and symbols for augmenting or replacing natural speech. The major aim of this proposal was to implement and evaluate the effectiveness of a computer-based MC communication system in nonspeaking individuals with aphasia. Eight individuals with severe chronic aphasia received extensive training on a special software program that turns a microcomputer into an electronic communication device. This software program is designed to offer representational graphic/pictorial symbols in conjunction with synthetic voice output to nonspeaking individuals. During the first phase of the training, participants were trained in two primary tasks: first, accessing the software program and identifying and manipulating the symbols/vocabulary items from different grammatical categories; second, constructing sentences using simple subject-verb-object syntax. Phase II involved providing each participant with a communication book which contained symbols specific to each individual subject. The caregivers and the subjects were trained on the efficient and effective use of the book. Overall, the results of this study reveal that individuals with severe aphasia are capable of learning the mechanics of a computer to access, manipulate, and combine graphic symbols to produce simple sentences. The finding that individuals with aphasia can learn computer-based graphic symbols has significant clinical and public policy implications.
Healthy Texans: The Veterinary Perspective
(Texas Department of Health, 1998-04) Rohde, Rodney E.; Hodges, Connie
No abstract prepared.
Privacy in Licensed Texas Long-Term Care Facilities
(1999-05) Bennett, Jo-Allison
The purpose of this research study was to discover how licensed Texas' long-term care facilities are currently addressing the issue of privacy. To achieve this objective, a survey was mailed to all of the 1,162 licensed Texas' LTC facilities (LTC facilities). The response rate was 37%. The profile which emerged from the data revealed that: (1) more responses came from "For Profit" LTC facilities than "Not for Profit" LTC facilities; (2) the mean number of residents per LTC facility is currently 106; (3) the majority of respondents considered privacy to be "very important" because residents have expressed a desire for privacy and respondents believe that privacy would improve residents' quality of life; (4) the mean percentage of residents, per LTC facility, who would/could use a private time room is currently 39.7%; (5) the majority of LTC facilities have provided staff with an inservice that addressed the issue of privacy within the past twelve months; (6) currently, the main obstacle to providing residents with opportunities for privacy is monetary in nature; and (7) currently, the two most common ways of offering residents privacy are "private rooms" and "outside sitting areas".
Typing of Rabies Virus Isolates by DNA Enzyme Immunoassay
(Elsevier, 1999-12) Sabouraud, Alain; Smith, Jean S; Orciari, Lillian A; de Mattos, Carlos; de Mattos, Cecilia; Rohde, Rodney E.
Background: Alternatives to antigenic typing are needed for epidemiologic surveys of the rabies virus associated with translocated coyotes and foxes, especially in areas where a closely related rabies virus is transmitted by striped skunks. Objectives: We developed and evaluated two enzyme based typing methods for rabies virus. The products of a reverse transcription-polymerase chain reaction (RT/PCR) or the nucleoprotein gene were hybridized to type specific probes and detected by enzyme assay after immobilization on microtiter plates. Study design: We tested RT/PCR products of 27 rabies isolates by two different DNA enzyme immunoassays (DEIA) and evaluated the quality of the results from the corresponding nucleotide sequence or the samples. Results: Using a set of two probes, one of the DEIAs correctly identified 26/27 samples as variants of rabies virus associated with either skunks, foxes, or coyotes. The identity of one fox rabies sample was unresolved by this assay. The second DEIA correctly identified 24/27 samples as variants of rabies virus associated with either skunks, foxes, or coyotes. This assay did not resolve the identity of two fox rabies samples, and misidentified one fox rabies sample as a skunk rabies sample. Conclusions: DEIA can be used for epidemiologic studies or variants of rabies virus associated with skunks, foxes, and coyotes. Both DEIA methods were effective when typing probes recognized changes at a minimum or two nucleotide positions between variants, but only one assay method was sufficiently stringent to detect a single base pair mismatch. The inherent mutability of RNA viruses must be considered when designing and evaluating typing methods.
Faith in Action: A Mutual Adoption Pact
(2000-05) Renick, Oren; Dolezal, Carl; Marlow, Tim; Barber, Stacey
The youth of today are being denied an opportunity to learn through service. Service can provide youth with a sense of direction and accomplishment. These foundations lead to confidence and compassion during the often tumultuous years of young adulthood. College and high school student organizations are ideal sites to teach service-excellence to tomorrow's leaders. The Southwest Texas State University's Student Chapter of the American College of Healthcare Executives (ACHE) is such an organization. The Mutual Adoption Pact (MAP) is an intergenerational service-mentoring program between youth and senior adults. The ultimate goal of MAP is to build enduring relationships that are mutually beneficial to those who give and receive care. Through this goal, those involved can gain a profound understanding of leadership, caring and service. Program description, development, and results are detailed for possible replication by other communities.
Quality Long Term Care: The Role of the Volunteer Ombudsman Part 1: Survey
(2000-05) Ostwald, Sharon K; Lees, Emily; Runge, Anke
The Long-Term Care Ombudsman Program is a federally mandated program to improve the quality of care received by residents of nursing homes throughout the United States. Certified volunteer ombudsman are specially trained to act as advocates and to help identify and solve problems on behalf of residents in long-term care facilitates. Texas relies heavily on volunteers to carry out this important role; the approximate ratio of paid staff to volunteers is 1:21. The primary aims of this survey of certified volunteer ombudsman in Texas were to (a) gain a better understanding of their experiences; (b) identify barriers to effective job performance; and (c) identify training needs and ongoing needs for education and support. Survey questionnaires were mailed to the 642 certified volunteer ombudsman in 28 regions in the state of Texas. Completed questionnaires were received from 361 volunteers for a return rate of 56%. Certified volunteer ombudsmen are predominantly women (73.6%) with an average age of 65 years. The majority of volunteers are retired and many have had previous experience in the health and social service fields. Many certified volunteer ombudsmen persist in the role for many years; in this study over 60 percent had been ombudsmen for three years or longer. In general, certified volunteer ombudsmen felt that they were most effective in performing tasks directly related to individual residents and in protecting the residents' rights. The certified volunteer ombudsmen felt least effective in resolving system-wide complaints and in influencing broader policy-related activities, such as promoting regulatory and legislative changes. Overall, certified volunteer ombudsmen were satisfied with their role and with their training program. Satisfaction was, however, related to age, education, and length of time as an ombudsman. Younger, better-educated volunteers, and especially those with professional nursing and social work experience, who had been in the ombudsman role for a shorter length of time were less satisfied with the role and with the training, than the older volunteers without professional experience in health care. Volunteers who had left the program were not surveyed. Training for certified volunteer ombudsmen occurs at the local level and is based on a curriculum developed by the State Ombudsman's Office. In general, certified volunteer ombudsmen were satisfied with the curriculum. However, many preferred a centralized training program in Austin to the current localized approach. Certified volunteer ombudsmen identified lack of a clear line of authority and lack of power as the two greatest barriers to their effectiveness. This report contains 30 recommendations for improvement including legislative changes, training suggestions, communication issues, and recruitment, recognition, reimbursement, and retention of volunteers.
Quality Long Term Care: The Role of the Volunteer Ombudsman Part 2: Focus Groups
(2000-05) Ostwald, Sharon K.; Lees, Emily; Runge, Anke
The Long-Term Care Ombudsman Program is a federally mandated program to improve the quality of care received by residents of nursing homes throughout the United States. Certified volunteer ombudsmen are specially trained to act as advocates and to help identify and solve problems on behalf of residents in long-term care facilities. Texas relies heavily on volunteers to carry out this important role; the approximate ratio of paid staff to volunteers is 1 :21. The primary aims of this study of certified volunteer ombudsmen in Texas were to (a) gain a better understanding of certified volunteer ombudsmen's experiences; (b) identify barriers to effective job performance; and (c) identify training needs and ongoing needs for education and support. In this qualitative part of the study (Part II), eight focus groups, totaling fifty-one certified volunteer ombudsman participants, were held in various geographic locations throughout the state. Groups were similar in their perception of the program and their role as certified volunteer ombudsmen. Experiences in respective facilities varied, however, and the attitudes of the long-term care facility administrators were a major cause of this variance. The regional staff ombudsmen were generally seen as supportive. Overall, the focus group participants appeared to perform their certified volunteer ombudsman duties effectively. They were most successful in addressing problems at the facility level. Focus group participants were generally satisfied with their training, but there was a strong preference for state-level training. The need for more interactive in-service training was expressed strongly by a majority. Many of the barriers to the certified volunteer ombudsmen's effectiveness were factors outside of their control. Within the facilities, they encountered a lack of trained personnel, as well as other problems inherent in institutionalized settings. Lack of power was identified as a major barrier. In addition to recommendations listed in the quantitative part of the study (Part I), the focus groups produced another set of 28 recommendations for improvement. These include suggestions for legislative changes; volunteer training and communication skills; as well as reimbursement, recruitment, recognition and retention of volunteers.
Eden Alternative: The Texas Project
(2000-05) Ransom, Sandy
Loneliness, helplessness, and boredom dominate the lives of many nursing home residents. Even though many regulations and programs are in place that are intended to assure quality of care, the confines of the nursing home environment and the widespread entrenchment of the "medical model" do not necessarily contribute to quality of life. Even the most modern and beautifully designed nursing homes sometimes seem to be pervaded with sterile overtones and lack the true warmth of a home. The Eden Alternative, a conceptual model developed by William H. Thomas, M.D., places the residents at the center of nursing home life. The nursing home is transformed into a "human habitat", an environment of diversity. Animals, plants and gardens, children and people of all ages form an integral, daily part of resident life. Residents regain a sense of worth as they care for the plants and animals and they share daily activities with the children as well as with each other. The management style is converted from a hierarchical model to a prototype in which decisions are moved closer to the residents. Staff members are empowered to form self-directed work teams and to take responsibility for managing their own work schedules. The Texas Eden Alternative project replicated Dr. Thomas' model in a different geographical location with a larger sample size. A multidisciplinary task force developed new instruments, recruited individuals willing to develop the Eden Alternative in their communities, and collected data. Resident and staff variables, which are known to influence the satisfaction and quality of life, were carefully gathered over a two-year time period. Although not all of Dr. Thomas' findings were validated in the Texas study, other outcomes showed promising trends. Both cumulative findings and results at specific individual homes have implications for continued research and future policy decisions.
Impact of the Eden Alternative™ on Texas Nursing Homes Residents' Quality of Life: A Psychosocial Perspective
(2001-01) Wylie, Rich
What effect does the Eden Alternative™ have on the quality of life of nursing home residents? Recent studies on this innovative approach to changing nursing home culture have yielded promising results using medical and administrative indicators. However, these studies have limited outcomes on psychosocial issues that influence the quality of life for nursing home residents. The purpose of this study was to address this limitation by conducting a more in-depth evaluation of the effectiveness of the Eden Alternative™ on nursing home residents' quality of life using scientifically proven reliable and valid psychosocial instruments; the Life Satisfaction Index (LSI) and the Sheltered Care Environment Scale (SCES) were chosen to measure the psychosocial variables. The evaluative research consisted of a two-year longitudinal study using a comparison pretest-posttest design. Three Texas nursing homes that initiated the Eden Alternative™ process ,were compared with two Texas nursing homes that did not initiate any aspect of the Eden Alternative™ model. The administration of questionnaires to residents, families, and staff were the primary means of data collection. Results brought to light two major issues that impacted the quantitative and qualitative outcome data. First, certain challenges surfaced during implementation of the Eden Alternative™ process. Secondly, clinical significance was not supported by the data. A discussion of these issues as well as recommendations for future research is provided.
A Practitioner's Guide to Culturally Sensitive Practice for Death and Dying
(2002-04) Cohoe, Merri; Contreras, Sue Ellen; Sparks, Debra
The purpose of this manual is to educate health care professionals in all areas of practice regarding religious and cultural beliefs in reference to end of life issues. This information is imperative to the helping process, and when utilized, will allow practitioners to provide the best possible service to clients. The following information is to be used as a general guideline and should not be considered definitive with respect to an individual's personal, religious, or cultural beliefs and perceptions. This manual is a collaboration of materials collected with the purpose of assisting practitioners in facilitating culturally and religiously sensitive service at this extremely fragile time in the helping process. In many circumstances, a lack of awareness or information deters professional engagement in times of grief and loss. This disengagement may be misconstrued as a lack of compassion, when in fact, the practitioner may lack the knowledge and cultural understanding required to serve diverse populations. This resource manual has been designed to enhance the multicultural perspective to include the traditions and beliefs of varied religions, denominations, and institutions concerning death and dying as a valuable component of practice applicable to diverse settings and professions. We encourage health care professions to utilize this tool, and when in doubt, to consult with the client. It is vital to remember that diversity exists not only between religions, but also within.
Bat Rabies, Texas, 1996–2000
(Center for Disease Control and Prevention, 2004-05) Rohde, Rodney E.; Mayes, Bonny C.; Smith, Jean S.; Neill, Susan U.
Bats submitted to the Texas Department of Health (1996–2000) were speciated and tested for rabies virus antigen by direct immunofluorescence microscopy. Antigenic analysis of rabies virus–positive specimens was performed with monoclonal antibodies against the nucleoprotein of the virus; atypical or unexpected results were confirmed by genetic analysis of nucleoprotein sequence.

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