Dissertation/Thesis Abstract

Discovering Barriers to Quality in Oklahoma Nursing Homes
by Myers, Julie Annette, Ph.D., The University of Oklahoma Health Sciences Center, 2017, 110; 10287164
Abstract (Summary)

Background: While the data indicate that Oklahoma’s nursing home care is lower in quality than the national average, there is a gap in the literature as to what staff perceive as barriers to quality care in Oklahoma. Staff perceptions impact organizational outcomes. Examining staff-perceived barriers presents the opportunity to approach improvement from the perspective of those responsible for implementing interventions.

Hypothesis: Nursing home staff in Oklahoma perceive the following as common barriers to delivering high quality care: (i) culture and structure of the organization; (ii) lack of authority and autonomy related to tasks and care delivery; (iii) high job demands related to disease burden; and (iv) limitations of the physical environment. The central question addressed is what do staff perceive as barriers to providing high quality care in Oklahoma nursing homes?

Methods: A written survey and interview guide were used to collect information from 28 nursing home staff from seven nursing homes in Oklahoma. The survey was crafted to test the perceptions of barriers in alignment with the conceptual model. Quantitative methods were used to determine the sample and analyze written survey responses. Qualitative methods were used to code themes from the interviews to elements of the conceptual model to determine if responses aligned with the hypothesis.

Results: Frequently cited barriers to delivering quality care include: social relationships inclusive of meals, care planning, activities, and dedicated staff time with residents; environmental factors inclusive of room size, privacy, layout, and access to outdoors; job demands inclusive of workload, time pressures, cognitive load, and demands from residents and families; performance evaluation, rewards, and incentives inclusive of recognition, appreciation, wage, bonus pay, performance feedback; and, supervisory and management style inclusive of consistency, equity, perceived fairness, and stress.

Conclusion: Real and perceived barriers to high quality care exist. Perceptions vary by staff role, and perceptions can be aligned with organizational structure and strategies through communication, transparency, and a justice-based approach. Along with changes to regulation and rules, improvement efforts must occur at the facility level with support from leadership and engagement of staff.

Indexing (document details)
Advisor: Bratzler, Dale W.
Commitee: Johnson, David, Kinney, Sharyl, Lorden, Andrea, Teasdale, Thomas
School: The University of Oklahoma Health Sciences Center
Department: Health Promotion Sciences
School Location: United States -- Oklahoma
Source: DAI-B 78/10(E), Dissertation Abstracts International
Subjects: Health sciences, Public health
Keywords: Barrier, Improve, Long term care, Nursing home, Quality, Staff perception
Publication Number: 10287164
ISBN: 978-1-369-84787-1
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