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policy implementation analysis: Nurse aide certification in Florida
Title
A policy implementation analysis: Nurse aide certification in Florida.
Creator
Brannon, Pamela Tarquinio, Florida Atlantic University, Schoenhofer, Savina, Clare, Donald A.
Abstract/Description
Policy implementation is recognized as a major component of the public policy process, and an important area for public administration research. The literature calls for the examination of public projects to improve policy design and implementation, for the comparison of expected implementation with actual implementation, and for the examination of the role of states in implementing federal policy. This dissertation addressed those areas by analyzing the implementation of the Omnibus Budget...
Show morePolicy implementation is recognized as a major component of the public policy process, and an important area for public administration research. The literature calls for the examination of public projects to improve policy design and implementation, for the comparison of expected implementation with actual implementation, and for the examination of the role of states in implementing federal policy. This dissertation addressed those areas by analyzing the implementation of the Omnibus Budget Reconciliation Act of 1987 (OBRA '87) which contains federal requirements for certification of nurse aides (nursing assistants) who are employed in Medicare and Medicaid funded nursing homes. The dissertation focused on the state of Florida and three levels of analysis: policies and practices of the state, nursing home operations and procedures, and individuals in the certification process. Multiple methods of data collection and data analysis were used and included: an analysis of the history, development and content of the federal policy, interviews with state administrators, a survey of nursing home administrators, an analysis of state certification statistics, documentary analysis, factor analysis and content analysis. Some of the data indicate that, although Florida has had a nurse aide certification process in place since 1982, there may be some uneven implementation of the certification process at the local level, and that race may have an impact on the certification rate. These areas were recommended for further study. A descriptive model, developed from the research design, outlined three dimensions that should be examined in order to conduct a comprehensive analysis of policy implementation: the origin of the policy, the agent of the policy, and the target of the policy. Additionally, a comprehensive analysis should examine the communication between the dimensions. In this dissertation, the federal legislation was the origin, the state of Florida was the agent, and nursing homes and prospective nurse aides were the targets. The descriptive model can be used for future implementation studies whether the origin of the policy is federal, state or local legislation.
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Date Issued
1993
PURL
http://purl.flvc.org/fcla/dt/40751
Subject Headings
Nurses' aides--Certification--Florida, Nursing home care--Florida
Format
Document (PDF)
Views of registered nurses and unlicensed assistive personnel on the differentiating aspects of their roles in a partnership model of care delivery
Title
Views of registered nurses and unlicensed assistive personnel on the differentiating aspects of their roles in a partnership model of care delivery.
Creator
Sorbello, Barbara C., Florida Atlantic University, Ray, Marilyn A.
Abstract/Description
The purpose of this study was to explore, through a descriptive method, views of registered nurses and unlicensed assistive personnel about their roles. Data sources included interviews with three registered nurses and three unlicensed assistive workers practicing in partnership on an acute patient care unit. Study findings supported role theory assertions that role strain and stress, manifested as role ambiguity, role confusion, role overlapping, and role overload occur when the role...
Show moreThe purpose of this study was to explore, through a descriptive method, views of registered nurses and unlicensed assistive personnel about their roles. Data sources included interviews with three registered nurses and three unlicensed assistive workers practicing in partnership on an acute patient care unit. Study findings supported role theory assertions that role strain and stress, manifested as role ambiguity, role confusion, role overlapping, and role overload occur when the role transition process and role expectations are not clarified or nurtured among role partners. Implications for nursing practice include the following: (1) Nurses in clinical and administrative practice need to be sensitized to the importance of nurses and ancillary personnel being active participants in the work redesign process, and must support the value of caring that transpires in the nurse-patient relationship. (2) Role theory can be utilized to understand dynamics that occur in work settings of nurses and assistive partners.
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Date Issued
1996
PURL
http://purl.flvc.org/fcla/dt/15305
Subject Headings
Differentiated nursing practice, Nursing services--Personnel management, Nurses--Attitudes, Nurses' aides, Nursing--Standards
Format
Document (PDF)
The experience of nurses caring for the primary caregivers of persons living with AIDS
Title
The experience of nurses caring for the primary caregivers of persons living with AIDS.
Creator
Stobie, Marjorie Michele., Florida Atlantic University, Appleton, Cathy
Abstract/Description
The rising incidence of Acquired Immune Disease Syndrome (AIDS), the increased length of survival for persons living with AIDS (PLWAs), and the associated high costs, suggest that patients will want and need to be cared for at home by family caregivers. If caring is the essence of nursing (Leininger, 1988a; Watson, 1985), then research on caring will expand nurses' understanding of what caring means to the recipient: the patients and their primary caregivers. The purpose of this...
Show moreThe rising incidence of Acquired Immune Disease Syndrome (AIDS), the increased length of survival for persons living with AIDS (PLWAs), and the associated high costs, suggest that patients will want and need to be cared for at home by family caregivers. If caring is the essence of nursing (Leininger, 1988a; Watson, 1985), then research on caring will expand nurses' understanding of what caring means to the recipient: the patients and their primary caregivers. The purpose of this phenomenological study of primary caregivers of PLWAs was to discover the meaning of their being cared for by the nurse. Colaizzi's (1978) method of data analysis was used. The experience of being cared for by the nurse for caregivers of PLWAs was knowing that they were in a relationship, in this together with a nurse who was there for them; experiencing the nurse's way of being as a competent friend; and being helped to cope with the experience of being a caregiver through specific nursing actions. Implications for practice, education and research are discussed.
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Date Issued
1994
PURL
http://purl.flvc.org/fcla/dt/15045
Subject Headings
AIDS (Disease)--Nursing, Caregivers, Chronically ill--Home care
Format
Document (PDF)
Medicaid incentive reimbursement programs in long-term care: An evaluation of the Florida Medicaid AIDS nursing home admission program
Title
Medicaid incentive reimbursement programs in long-term care: An evaluation of the Florida Medicaid AIDS nursing home admission program.
Creator
Cruise, Peter L., Florida Atlantic University, Clare, Donald A.
Abstract/Description
This study evaluated the Florida Medicaid Acquired Immunodeficiency Syndrome (AIDS) nursing home admission incentive program using goal attainment and constituency satisfaction criteria. The program provides additional reimbursement to nursing homes which admit Medicaid-covered persons with AIDS (PWAs). Goal attainment, i.e., increasing the rate of PWA admissions, was assessed using ICD-9-CM coded (for AIDS) Medicaid-covered hospital discharges to nursing homes as a surrogate nursing home...
Show moreThis study evaluated the Florida Medicaid Acquired Immunodeficiency Syndrome (AIDS) nursing home admission incentive program using goal attainment and constituency satisfaction criteria. The program provides additional reimbursement to nursing homes which admit Medicaid-covered persons with AIDS (PWAs). Goal attainment, i.e., increasing the rate of PWA admissions, was assessed using ICD-9-CM coded (for AIDS) Medicaid-covered hospital discharges to nursing homes as a surrogate nursing home admission measure. To assess satisfaction, both program constituencies--hospitals (N = 120) which place and nursing homes (N = 308) which agree to admit PWAs--were surveyed in 10 counties. For both constituencies, the surveys were designed to measure satisfaction along two dimensions: (1) the degree of satisfaction with the Florida program, and (2) the level of agreement with the general concept of incentive reimbursement. For nursing homes, the survey also measured: institutional characteristics, financial characteristics, and medical and technological issues. The goal attainment results revealed that the PWA admission rate showed no meaningful change over the five years studied. The constituency satisfaction results revealed that both constituencies were moderately satisfied with the Florida program and incentive programs generally, but that such satisfaction was not related to the number of PWAs admitted to nursing homes. Nursing home institutional characteristics and medical issues were not related to the number of PWAs admitted, but financial characteristics and technological issues were significantly (but negatively) related. The following policy implications were drawn. Although the Florida program did not meet its goal, both constituencies were satisfied with the program and incentives generally, leaving open the possibility for program modification. The previously unconfirmed concern that nursing homes fear intergenerational problems if PWAs were to be admitted was supported by the findings, but nursing home assertions that their lack of appropriate technology restricts PWA admissions were not.
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Date Issued
1995
PURL
http://purl.flvc.org/fcla/dt/12397
Subject Headings
Nursing homes--Florida--Cost control, Medicaid--Florida, AIDS (Disease)--Patients--Services for--Florida--Cost effectiveness, AIDS (Disease)--Patients--Long-term care--Florida--Cost effectiveness
Format
Document (PDF)
Care at Work: A Feminist Analysis of the Long-Term Care Industry in the United States
Title
Care at Work: A Feminist Analysis of the Long-Term Care Industry in the United States.
Creator
Tunick, Rachel, Beoku-Betts, Josephine, Lange, Bernadette, Florida Atlantic University, Dorothy F. Schmidt College of Arts and Letters, Center for Women, Gender and Sexuality Studies
Abstract/Description
This research provides a feminist perspective on the lowest paid sector of the United States long-term care industry, Certified Nursing Assistants. This research adds to current feminist scholarship on the modern professional caregiving industry by focusing on the perspective of the workers. As the population of older adults requiring care is expected to increase over the coming decades, the demand for paid caregivers will increase as well. Historically, care work was an expected duty done...
Show moreThis research provides a feminist perspective on the lowest paid sector of the United States long-term care industry, Certified Nursing Assistants. This research adds to current feminist scholarship on the modern professional caregiving industry by focusing on the perspective of the workers. As the population of older adults requiring care is expected to increase over the coming decades, the demand for paid caregivers will increase as well. Historically, care work was an expected duty done freely by the women of the family, but today much of the vital intimate caring labor is relegated to paid caregivers. I examine how alternative social, political and economic frameworks can transform United States society’s attitude towards the increasingly relevant issue of caring labor. I argue that incorporating a feminist perspective will be helpful in developing a sustainable model for caring labor that acknowledges the dignity of both patients and their caregivers.
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Date Issued
2016
PURL
http://purl.flvc.org/fau/fd/FA00004801, http://purl.flvc.org/fau/fd/FA00004801
Subject Headings
Nurses' aides., Medical personnel-caregiver relationships., Nursing homes--Employees--Attitudes., Feminist theory., Caring--Moral and ethical aspects., Feminism--Political aspects., Long-term care facilities--Administration., Nursing home patients--Care., Older people--Nursing home care.
Format
Document (PDF)