Untitled Document

Research

Barbara Bowers

Ph.D., University of California, San Francisco
Helen Denne Schulte Professor,
Associate Dean for Research, Department of Nursing
bjbowers@wisc.edu
http://www.son.wisc.edu/people/faculty/bowers.html

Long Term Care. Caregiving, Workforce Development, Organizational Culture, and Public Policy.

The overall goal of my research is to explore the relationship between public policy and the organization and quality of long term care services. The findings from my early work on caregiving led me to questions about the context within which care is delivered (particularly policy) and the many influences of that context on the care provided. Most of this work has been in long term care settings or with long term/chronically ill patient populations.

I have explored family caregiving at home and as it continues in nursing home settings. I have also investigated how nurse-aides in nursing homes conceptualize and organize their work. Primarily through patient observation, the work suggested that nurse-aides were taught what would be expected of them, but were not taught how to organize their work. While the actual tasks were experienced as unpleasant or difficult by some, all new nurse-aides found it extremely difficult to organize. Most learning occurred in isolation resulting in a variety of approaches to the "same" work. One common consequence of developing a work style, under the simultaneous conditions of 1) invisibility of the work process, and 2) impossible work demands, was that the nurse-aides learned quickly to cut corners in ways least likely to get them into trouble with supervisors, peers, and family members. The invisible work cut from the work routine tended to fall into the category that families identified as necessary for protecting the residents' dignity. The process of routinizing the care and rendering it as predictable as possible resulted in what families perceived as poor quality care delivery, which ignored the importance of protective caregiving. Since that time, I have conducted the following studies:

How the Wellspring model of nursing home culture change affects staff morale and resident outcomes.
How families and residents use the state nursing home complaint process and its expenditures.
How older adults experience transitions from assisted living to nursing home settings.
How nursing home residents at different levels of dependency think about care quality.
How generally well older adults determine quality in their care providers.

Representative Publications
McGilton, K., Bowers, B., McKenzie-Green, B., Boscart, V., & Brown, M. (In Press) Against all odds: How do charge nurses get through their day? Exploring and understanding the supervisory role in long-term care. Journal of Applied Gerontology.

Buckwalter, K.C., McCarthy, A.M., Bowers, B., Beck, C., & Hartzler, L.E. (2009). Intervention research in highly unstable environments. Research in Nursing and Health, 32(1), 110-121.

Bowers, B., & Schatzman, L. (2009). Dimensional analysis. In J. Morse, P. Stern, J. Corbin, B. Bowers, K. Charmaz, & A. Clarke (Eds.), Developing grounded theory: The second generation. Developing qualitative inquiry series. Left Coast Press.

Bowers, B. (2008). A well prepared and supported workforce. In M. Downs & B. Bowers (Eds.), Excellence in dementia care: Research into practice. London: McGraw-Hill Publishers.

Bowers, B., Bigby, C., & Webber, R. (2008). Intellectual disability and aging. In Nay & Garratt (Eds.), Interdisciplinary care of older people: Issues and innovations. Sydney: Elsevier.

Bigby, C., Webber, R., Bowers, B., & MacKenzie-Green, B. (2008). A survey of people with intellectual disabilities living in residential aged care facilities in Victoria. Journal of Intellectual Disability Research, 52(5), 404-414.

Downs, M., & Bowers, B. (2008). Caring for people with dementia [Editorial]. British Medical Journal, 336, 225-226.

Landefeld, C.S., Bowers, B.J., Feld, A.D., Hartmann, K.E., Hoffman, E., Ingber, M.J., King, J.T. Jr., McDougal, W.S., Nelson, H., Orav, E.J., Pignone, M., Richardson, L.H., Rohrbaugh, R.M., Siebens, H.C., & Trock, B.J. (2008). National Institutes of Health state-of-the science statement: Prevention of fecal and urinary incontinence in adults. Annals of Internal Medicine, 148, 449-458.

Pandhi, N., Bowers, B., & Chen, F. (2007). A comfortable relationship: A patient derived dimension of ongoing care. Family Medicine, 39(4), 266-73.

Webber, R., Bigby, C., McKenzie-Green, B., & Bowers, B. (2007). Mapping the terrain: Aging people with lifelong intellectual disability living in residential aged care facilities in Victoria. Quality of Life and Social Justice Flagship, Australian Catholic University, and La Trobe University.

Bowers, B.J., & Nolet, K. (2006). Promising practices in care planning for nursing home patients. Report to Agency for Health Research and Quality. Baltimore, MD: U.S. Department of Health and Social Services.

Dosa, D., Bowers, B., & Gifford, D. (2006). Critical review of resident assessment protocols. Journal of the American Geriatrics Society, 54, 659-666.

Bowers, B., Esmond, S.L., Norton, S., Holloway, E. (2006). The consumer/provider relationship as care quality mediator. In S. Kunkel & V. Wellin (Eds.), Consumer voice and choice in long-term care (Ch. 10). New York: Springer Publ. Co.

Mezey, M., Burger, S., Bloom, H.G., Bonner, A., Bourbonniere, M., Bowers, B., et al. (2005). Experts recommend strategies for strengthening the use of advanced practice nurses in nursing homes. Journal of the American Geriatric Society, 53, 1790-1797.

Bowers, B. (2005). Forward. In J. Gaugler (Ed.), Promoting family involvement in long-term care settings (pp. xi-xiii). Baltimore, MD: Health Professions Press.

Lutz, B.J., & Bowers, B.J. (2003). Understanding how disability is defined and conceptualized in literature. Rehabilitation Nursing, 28(3), 74-8.

Bowers, B.J., Esmond, S., & Jacobson, N. (2003). Turnover reinterpreted: CNAs talk about why they leave. Journal of Gerontological Nursing, 29(3), 36-43.

Lutz, B., Bowers, B.J., Esmond, S., & Jacobson, N. (2003). Improving primary care for persons with disabilities: The nature of expertise. Disability & Society, 18(4), 443-55.

Caron, C.D., & Bowers, B.J. (2003). Deciding whether to continue, share or relinquish caregiving: Caregiver views. Qualitative Health Research, 13(9), 1252-71.

Bowers, B. (2002). Best practice in care management. Journal of Social Work in Long Term Care, 1(3), 55-71.

Bowers, B. (2002). The work of nurses and nurse aides in nursing homes. Institute of Medicine, National Academy of Sciences.

Lauver, D.R., Ward, S.E., Heidrich, S.M., Keller, M.L., Bowers, B.J., Brennan, P.F., Kirchhoff, K.T., & Wells, T.J. (2002). Patient-centered interventions. Research in Nursing and Health, 25(4), 246-255.

Bowers, B. (2001). Organizational culture change in long term care. Urban Institute, Assistant Secretary for Planning & Evaluation, U.S. Dept. of Health & Social Services.

Bowers, B. (2001). State complaint investigations systems: A report of findings from residents and families. Report to The Centers for Medicare and Medicaid Services.

Bowers, B.J., Lauring, C., & Jacobson, N. (2001). How nurses manage time and work in long-term care facilities. Journal of Advanced Nursing, 33(4), 484-491.

Bowers, B., Fibich, B., & Jacobson, N. (2001). Care as service, care as relating, care as comfort: Understanding nursing home residents' perceptions of quality. The Gerontologist, 41(4), 539-45.

Caron, C., & Bowers, B. (2000). Methods and application of dimensional analysis: A contribution to concept and knowledge development in nursing. In B.L. Rodgers & K.A. Knafl (Eds.), Concept Development in Nursing, Foundations, Techniques and Applications (pp. 285-319). Philadelphia: W.B. Saunders Co.

Bowers, B., Esmond, S., & Jacobson, N. (2000). The relationship between staffing and quality in long-term care facilities: Exploring the views of nurse aides. Journal of Nursing Care Quality, 14(4), 55-64.

Zimmerman, D.R., & Bowers, B.J. (2000). Satisfaction surveys and other sources of information on quality of long-term care. In J. Cohen-Mansfield, F. Ejaz, & P. Werner (Eds.), Satisfaction surveys in long-term care (Ch. 10). New York: Springer Publ. Co.

Bowers, B. (1996). The relationship between staffing and quality in long term care facilities. Report to 105th US Congress, Subcommittee on Health: Appropriateness of Minimum Nurse Staffing Ratios.

Bowers, B., & Becker M. (1992). Nurse aides in nursing homes: The relationship between organization and quality. The Gerontologist, 32(3), 360-366.

Bowers, B. (1989). The grounded theory method: From conceptualization to research process. In B. Sarter (Ed.), Paths to knowledge: Innovative research methods in nursing. Nursing National League for Nursing.

Bowers, B. (1988). Family perceptions of care in nursing homes. The Gerontologist, 28(3), 361-368.

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