This article develops a relational perspective on the coordination of work. Existing theory suggests that relational forms of coordination should improve performance in settings that are highly interdependent, uncertain and time‐constrained. Going beyond previous work, we argue that relational coordination should also improve job satisfaction by helping employees to accomplish their work more effectively and by serving as a source of positive connection at work. Using a cross‐sectional sample of nursing aides and residents in 15 nursing homes, we investigate the impact of relational coordination on quality outcomes and job satisfaction.
The finding that greater job commitment of CNAs is associated with better quality of relationships and life for residents implies that better jobs lead to better care. Culture change transformation that increases CNA autonomy, knowledge input, and teamwork may not increase workers' commitment to jobs without improvements in basic supervision.
Findings from the 1995 National Nursing Home Survey suggest that elderly Americans are reducing their use of nursing home care. The numbers reflect a change in the role of the nursing home, as defined in this survey. By 1995 nursing facilities were increasingly focusing on patients with greater disability and postacute care needs. Preferred alternatives, most notably home-delivered care and assisted living, were likely filling the gap left by declining nursing home use. Better population-based studies are needed to track emerging trends and ascertain whether elders with disabilities are receiving the care they need. Such data could inform development of better public and private financing strategies for long-term care.
This is the first investigation of nursing assistant job satisfaction using a nationally representative sample of nursing assistants matched to information about their employing nursing homes. The findings corroborate results of previous studies in showing that compensation and working conditions that provide respect, good relationships with supervisors, and better staffing levels are important to nursing assistant job satisfaction.
These results suggest that management of patients with advanced DAT on a DSCU using a palliative care philosophy may result in less patient discomfort and lower costs than management on a TLTC.
This is the first analysis to use a weighted, nationally representative sample of home health workers linked with agency-level data. The findings suggest that intention to leave the job may be reduced through policies that prevent injuries, improve consistency of client assignment, improve experiences among African American workers, and offer sufficient hours to workers who want them.
Objectives
In the Fluid and Catheter Treatment Trial (FACTT) of the National
Institutes of Health Acute Respiratory Distress Syndrome Network, a
conservative fluid protocol (FACTT Conservative) resulted in a lower
cumulative fluid balance and better outcomes than a liberal fluid protocol
(FACTT Liberal). Subsequent Acute Respiratory Distress Syndrome Network
studies used a simplified conservative fluid protocol (FACTT Lite). The
objective of this study was to compare the performance of FACTT Lite, FACTT
Conservative, and FACTT Liberal protocols.
Design
Retrospective comparison of FACTT Lite, FACTT Conservative, and FACTT
Liberal. Primary outcome was cumulative fluid balance over 7 days. Secondary
outcomes were 60-day adjusted mortality and ventilator-free days through day
28. Safety outcomes were prevalence of acute kidney injury and new
shock.
Setting
ICUs of Acute Respiratory Distress Syndrome Network participating
hospitals.
Patients
Five hundred three subjects managed with FACTT Conservative, 497
subjects managed with FACTT Liberal, and 1,124 subjects managed with FACTT
Lite.
Interventions
Fluid management by protocol.
Measurements and Main Results
Cumulative fluid balance was 1,918 ± 323 mL in FACTT Lite,
−136 ±491 mL in FACTT Conservative, and 6,992 ± 502
mL in FACTT Liberal (p < 0.001). Mortality was not
different between groups (24% in FACTT Lite, 25% in FACTT
Conservative and Liberal, p = 0.84).
Ventilator-free days in FACTT Lite (14.9 ±0.3) were equivalent to
FACTT Conservative (14.6±0.5) (p = 0.61)
and greater than in FACTT Liberal (12.1 ±0.5, p
< 0.001 vs Lite). Acute kidney injury prevalence was 58% in
FACTT Lite and 57% in FACTT Conservative (p
= 0.72). Prevalence of new shock in FACTT Lite (9%) was
lower than in FACTT Conservative (13%) (p =
0.007 vs Lite) and similar to FACTT Liberal (11%)
(p = 0.18 vs Lite).
Conclusions
FACTT Lite had a greater cumulative fluid balance than FACTT
Conservative but had equivalent clinical and safety outcomes. FACTT Lite is
an alternative to FACTT Conservative for fluid management in Acute
Respiratory Distress Syndrome.
Background
Newborn screening (NBS) occupies a unique space at the intersection of translational science and public health. As the only truly population-based public health program in the United States, NBS offers the promise of making the successes of translational medicine available to every infant with a rare disorder that is difficult to diagnose clinically, but for which strong evidence indicates that presymptomatic treatment will substantially improve outcomes. Realistic NBS policy requires data, but rare disorders face a special challenge: Screening cannot be done without supportive data, but adequate data cannot be collected in the absence of large-scale screening. The magnitude and scale of research to provide this expanse of data require working with public health programs, but most do not have the resources or mandate to conduct research.
Methods
To address this gap, we have established Early Check, a research program in partnership with a state NBS program. Early Check provides the infrastructure needed to identify conditions for which there have been significant advances in treatment potential, but require a large-scale, population-based study to test benefits and risks, demonstrate feasibility, and inform NBS policy.
Discussion
Our goal is to prove the benefits of a program that can, when compared with current models, accelerate understanding of diseases and treatments, reduce the time needed to consider inclusion of appropriate conditions in the standard NBS panel, and accelerate future research on new NBS conditions, including clinical trials for investigational interventions.
Trial registration
Clinicaltrials.gov registration #
NCT03655223
. Registered on August 31, 2018.
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