The purpose of this research was to describe the kinds of pain assessments nursing home staff use with nursing home residents and the characteristics and behaviors of residents that staff consider as they assess pain. Twenty-one focus groups were held in 12 nursing homes. Nurses and other nursing home staff attended the focus groups. Coding techniques consistent with ethnographic methodology were used for data analysis. Four themes identified an underlying uncertainty in assessing residents' pain, the staff relationship-centered approach to pain assessment, the resident cues that alert staff to pain, and residents' characteristics important to the nursing assessment. Composition of focus groups made a difference in participation of certified nursing assistants in focus group discussion. Urban and rural differences were noted across the focus groups. Research is needed to further refine pain assessment techniques specifically for nursing home settings.

Issues important to CNAs revolved around basic motivational factors, such as job enrichment opportunities, personal growth opportunities, recognition, responsibility, and sense of achievement. Leadership must become creative and build on that base, providing CNAs with job mobility, job enrichment opportunities, recognition, and increased job responsibility, producing positive outcomes not only for the CNA but also for the resident and the facility.

Exploring selected working conditions and performance in nursing homes suggests that high and low performers can be determined based on both quantitative and qualitative findings.

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Although there is extant research on the homeless, less is available suggesting an innovative community partnership such as Project HOPE. This partnership provided baccalaureate nursing students with greater understanding of underserved populations and health care delivery systems, and encouraged their future work with marginalized populations upon graduation. Students collected descriptive information on the homeless population. Correlations were found among site placement: age, clothing and supplies given, wound care, referrals given, assessments, and season of the year. Student evaluations revealed paradigm shifts in attitudes and inspired advocacy toward this population. Through the descriptive information and qualitative comments, we gained insight on demographics, conditions observed, and interventions offered, which provided direction for quality improvement in curriculum design for the Community Health Nursing course, direction for future student groups working in shelters and with street outreach workers, and information useful to strengthening partnerships with local organizations working with the homeless population.

<h4></h4> <p>The purpose of this study was to describe the characteristics, work perceptions, and factors influencing employment of second-career certified nursing assistants (CNAs) in nursing homes. The qualitative descriptive design included a purposeful sample of 17 participants from 5 nursing homes. Data generation consisted of demographic surveys and audiotaped interviews that were transcribed, coded, and analyzed for emerging themes. Four themes were identified: negative first impressions of the work did not deter second-career CNAs, second-career CNAs lived out personal ideals and values through their work, positive relationships and job benefits retained second-career CNAs, and second-career CNAs expressed hopes for transforming nursing homes. Results revealed a group of committed, mature workers to fill labor shortages in an essential health care setting.</p>

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