Factors Influencing the Perceived Quality of Nursing Home Visits
Sponsored by Missouri Western State University Sponsored by a grant from the National Science Foundation DUE-97-51113
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The proper APA Style reference for this manuscript is:
LAW, G.L. (1998). Factors Influencing the Perceived Quality of Nursing Home Visits. National Undergraduate Research Clearinghouse, 1. Available online at http://www.webclearinghouse.net/volume/. Retrieved May 29, 2017 .

Factors Influencing the Perceived Quality of Nursing Home Visits
GAYLE L. LAW
Missouri Western State University DEPARTMENT OF PSYCHOLOGY

Sponsored by: Brian Cronk (cronk@missouriwestern.edu)
ABSTRACT
Nursing homes have become an integral part of society as a result of the constantly expanding elderly population. Often, there is a noticeable lack of interaction between the residents of these homes and the community as a whole, implicating a pressing need for visitors in skilled nursing facilities. Thus, the purpose of this experiment was to pinpoint how certain factors such as frequency and length of a visit and various attributes of the visitor influence the residents` enjoyment of the visit. This was accomplished over a two-week period by having the researcher orally survey 30 residents of the LaVerna Village nursing home in Savannah, Missouri after they had received a non-employee visitor.Although it was expected that frequency and length of a visit would show a strong, positive correlation with the residents` enjoyment rating, a weak correlation was discovered between both frequency and length of a visit and residents` enjoyment of the visit. A number of other factors including: a familial relationship with the resident, visiting in groups, a mixture of male and female visitors, and a combination of talking and engaging in an activity were each expected to influence the residents` enjoyment of the visit, yet only a familial relationship with the resident was found to influence the enjoyment ratings.Because the study relied solely upon a self-reporting method, there was a greater possibility of problems with reliability and variable accuracy. Possible avenues for future research on visits in skilled nursing facilities include studies on visits with minorities in nursing homes and research evaluating the effectiveness of companion pet therapy.

INTRODUCTION
Society has seen a gradual increase in life expectancies due in large part to medical developments and technological advances. With the prolongment of life expectancies, came about the creation of nursing homes. Nursing homes emerged out of the concept of almshouses, poor farms, and boarding homes in the mid-1930`s as a result of Social Security legislation which prohibited funding from going directly to the residents of these public institutions (Barney, 1974). Today, there are over five million nursing home residents in the United States alone (Area Agency on Aging, 1996). Thus, nursing homes have become a prominent force in society calling for detailed research and study. Nursing homes were established to meet the needs of the elderly in three main capacities including medical attention, emotional stability, and social interaction (Barney, 1974). There has been a lack of research compiled to evaluate nursing homes` effectiveness in carrying out the stated objectives, yet what little research that has been completed suggests that residents do not receive optimal treatment in most of these areas. This contradicts the Omnibus Reconciliation Act (OBRA) of 1978, which mandated that nursing homes provide services to attain and maintain the mental, physical, and psychosocial well-being of residents (Area Agency on Aging, 1996).Because of this reality, there are a number of negative stigmas attached to nursing homes, which have been permeated throughout society over the years. For example, most families view nursing homes as a sort of final resting place with a sense of guilt because they feel as though they are abandoning their loved ones during their last few years (Marsden, 1992). Admittedly, almost one-third of residents die during their first year after their initial placement in a nursing home (Area Agency on Aging, 1996). Other common stereotypes of older persons imply that most elderly people are senile, sickly, and set in their ways. However, often the exact opposite is true. For instance, positive aspects of aging can include improved judgement and wisdom, increased self-awareness, and freedom as well as the advantage of sharing life experiences with others (LaBrake, 1996). Some of these statistics are due in part to the natural progression of aging and the fact that many incoming residents are terminally ill and recently discharged from hospitals. Also, because many of the nursing homes are profit based organizations, several aspects of the home are directed in a business manner, affecting the quality of care residents receive. In terms of medical attention, many facilities lack the appropriate amount of staff, thus, greatly reducing the level of service residents receive. A study conducted by Bourestom and Gottesman (1974) found through direct observation that residents received some form of nursing service from a professional staff member only 2% of the time over almost 27,000 observations. This seems to be a trend in most nursing homes, which also affects the mental and social capacities of residents. Mentally, aging can be viewed as a time of awakening in which residents can learn new hobbies and skills. However, the same study by Bourestom and Gottesman (1974) which used a modified version of the Kahn-Goldfarb Mental Status Questionnaire, found that 53% of residents were either confused or only moderately alert when asked the current date and their name. According to an experiment conducted by Arthur, Donnan, and Lair (1973), residents were observed spending an average of four or more hours a day sitting alone in a room without engaging in an activity. These findings implicate the need for increased social activity involving such items as a community presence in the nursing home as well as increased staff interaction with residents.Although the government has pushed for increased volunteerism, negative misconceptions have plagued nursing homes because of the aforementioned stigmas attached to the aging process. This makes providing a socially stimulating environment for nursing homes more difficult. The administrators and staff of the homes argue that they cannot meet the social needs of residents without the active involvement of community and family members, yet these are often the same individuals who are circulating the myths of nursing homes and the elderly. One explanation noted by Berkowitz (1987) was given by a nursing home volunteer who reasoned that, "We need to confirm our fears about the aging process….that it is really valid to stay in touch with the part of you that is insecure and scared and frightened about being mortal" (p. 99). In order to improve the physiological, psychological, and social well-being of nursing home residents, research has found that residents must have interaction with others. Collier, Lawrence, and Prawitz (1994) illustrated that when family members frequently visited residents, they were more capable of assessing the quality and aspects of care the resident was receiving. Rather than creating social boundaries between institutions and communities that stifle interactions, experimenters postulate that residents need visitors from outside of the facility. One such study by Arthur et al. (1973) noted a significant improvement in the morale of residents after a period of companionship with undergraduate students. Another study by Hook, Oak, and Sobal (1982) examined factors affecting frequency of visitation such as sex, distance from the institution, and familial relations with the resident, yet to this date, there have been few studies which have determined which aspects of a visit make a visit enjoyable on the part of the resident. Therefore, the purpose of this experiment was to pinpoint which factors residents considered to most influence the quality of a visit. More specifically, the study attempted to determine how frequency and length of a visit as well as different attributes of the visitor and the relationship between visitors and residents influenced residents` perceived enjoyability of the visit.


METHOD

PARTICIPANTS
The participants in this study included 30 elderly residents (24 women and 6 men) of the LaVerna Village nursing home in Savannah, Missouri, which is a rural, Midwestern community of about 4,500 people. LaVerna Village is a church affiliated, for-profit skilled nursing home facility with approximately 120 residents. Skilled nursing homes provide 24-hour accommodation, food, and skilled nursing care for residents.

MATERIALS
A seven-question survey was elicited in this experiment (Refer to Appendix). The first of these questions inquired about the number of visitors the resident just received, whereas the second question determined the sex of those visitors. Other questions served to investigate whether the visitors were related to the resident and how the visitors spent most of their time together. Further questions determined the frequency in which the visitors visited the resident, as well as the actual length of the visit. Finally, residents were asked to rate their enjoyment of the visit.

PROCEDURE
This experiment was conducted over a period of two weeks by having the researcher approach 30 nursing home residents with the seven-question survey after someone who is not an employee of LaVerna Village had visited them. The questionnaire was conducted orally, with the researcher asking the survey questions while recording the residents` answers.


RESULTS
Overall, three one-way ANOVA tests were conducted. The first one-way ANOVA was calculated to compare the number of visitors the resident had just received to the reported enjoyment of the visit. No significant difference was found (F(2, 27)=.308, p>.05). Thus, the residents` enjoyment rating did not differ significantly regardless of the number of visitors the resident received. The second one-way ANOVA test was calculated in order to compare the visitors` sex to the residents` enjoyment rating. However, no significant difference was found (F(2, 27)=.244, p>.05). Once again, the residents` enjoyment rating did not differ significantly whether the visitors were male, female, or a group of both men and women. The final one-way ANOVA compared whether the visitor spent a majority of their visit talking, engaging in an activity with the resident, or split evenly between the two activities to the residents` overall enjoyment rating. No significant difference was found (F(1, 28)=.122, p>.05). Regardless of whether the visitors spent most of their time talking with the resident or split evenly between talking and engaging in an activity, the residents` reported enjoyment of the visit did not differ significantly. Also, an independent t-test, which was utilized to compare the enjoyment of the visit to whether the visitor was a relative of the resident, found a significant difference in that residents preferred visitors who were relatives over visitors with whom they were not related (t(28)=-6.109, p>.001). The enjoyment ratings of the visits in which the visitors were related were significantly higher (M=92.66, sd=8.53) than the enjoyment ratings of visits from non-relative visitors (M=68.08, sd=3.92). In addition, two Pearson correlations were conducted to determine the strength of the relationship of length and frequency of visits to the reported enjoyment of the visit. The first Pearson correlation was calculated examining the strength of the relationship between the number of times per year the visitors usually visit the resident and the residents` enjoyment of the visit. A weak, negative correlation was found (r(28)=-.005, p>.05). Therefore, frequency of visits was not related to the residents` enjoyment of the visit. The second Pearson correlation was calculated to examine the strength of the relationship between the length of the visit in minutes and the residents` enjoyment of the visit. A weak, non-significant correlation was found (r(28)=.257, p>.05). Just as frequency was not related to residents` enjoyment of the visit, length of the visit was also not related to enjoyment ratings.


DISCUSSION
Initially, it was expected that frequency and length of a visit would show a strong, positive correlation with the residents` enjoyment rating. However, statistical analysis showed a weak, non-significant correlation between both length and frequency of a visit and the residents` enjoyment of the visit. The same lack of significance was found for the sex of the visitors as well as the number of visitors the resident received. Here, a combination of male and female visitors in addition to a greater number of visitors were each expected to influence the residents` enjoyment rating of the visit. Along the same lines, it was hypothesized that a mixture of talking and performing an activity would make the visit more enjoyable for the resident as compared to solely talking or engaging in an activity, yet no significant difference was found between the type of activity the visitors engaged in and the residents` enjoyment rating. Still, in terms of familial relationships, a significant difference was found in that visits from relatives were rated significantly higher as was expected. These findings concur with previous research by Arthur et al. (1973), which stated that residents experienced improved morale upon interaction with visitors in that all of enjoyment ratings were at or above a rating of 50 on a 100 point scale. This study also reiterated the findings of Hook et al. (1982) by finding that a familial relationship between visitors and residents influences the residents` enjoyment of the visit. However, contrary to the work of Hook et al. (1982), which stated that frequency and length of visits were important in lifting residents` morale, no strong relationship was discovered between these factors and the residents` enjoyment rating. Slight limitations of the study included the fact that the study relied solely upon self-reporting, thus allowing for g greater possibility of problems with reliability and variable accuracy. In terms of external validity, the study was applicable to larger Midwestern populations of skilled nursing home facilities because the sample gathered a traditional representation of participants such as a greater number of females. Also, LaVerna Village is representative of most Midwestern nursing homes in terms of size and services offered. However, in order for this study to be generalized to nursing homes on a broader scale, more minorities should be included. For this reason, future research could focus specifically on minorities in skilled nursing facilities. In the same manner, researchers could examine how companion therapies such as pet therapy affect residents` morale and overall satisfaction with the facility.


REFERENCES
Area Agency on Aging. (1996). Missouri long-term care ombudsman training and resource manual. Albany, Missouri. Arthur, G. L. , Donnan, H. H. , & Lair, C. V. (1973). Companionship therapy with nursing home aged. The Gerontologist, 13, 167-170. Barney, J. L. (1974). Community presence as a key to quality of life in nursing homes. American Journal of Public Health, 3, 265-268. Berkowitz, B. (1987). Local heroes. New York, NY: Lexington Press. Bourestom, N. C. , & Gottesman, L. E. (1974). Why nursing homes do what they do. The Gerentologist, 14, 501-506. Collier, M. W. , Lawrence, F. C. , & Prawitz, A. D. (1994). Families as monitors of quality of care in nursing homes. Psychological Reports, 75, 1242. Hook, W. F. , Oak, J. C. , & Sobal, J. (1982). Frequency of visitation in nursing homes: Patterns of contact across the boundaries of total institutions. The Gerentologist, 22, 424-428. LaBrake, T. (1996). How to get families more involved in the nursing home: Four programs that work and why. New York, NY: Haworth Press. Marsden, A. M. (1992). Helping caregivers confront nursing home challenges. Journal of Home Economics, 84(1), 2-7.


APPENDIX
1. How many visitors did you have?2. Were your visitors male, female, or both?3. Were your visitors related to you?4. Did you spend most of your time doing an activity together, talking, or split evenly between the two?

5. How often do you visit with this person? Daily Weekly Monthly Yearly Less Frequently

6. How long was your visit?

7. On a scale from 0 to 100, with 100 being the most enjoyable, how would you rate your enjoyment of the visit?

Submitted 12/3/98 12:55:40 PM
Last Edited 12/3/98 1:20:03 PM
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