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Biology of Aging

Barbara Bowers

Barbara Bowers

Ph.D., University of California, San Francisco
Helen Denne Schulte Professor,
Associate Dean for Research, Department of Nursing

Caregiving Models and Practices for Frail, Older Adults

My research has focused on organizational models and work practices in long term care settings. My early work focused on descriptive studies exploring how family and paid caregivers in the home and in institutional long term care settings understand their work and the conditions that most influenced their work. Built on this early descriptive work I conducted several descriptive studies of innovative programs designed to improve the quality of care and work life quality. These included studies of: interventions to improve staff skill and competency, culture change model implementation, the relationship between care models and clinical outcomes, staff/patient relationships, and transitions from acute to long term care. My international collaborations have included work in: Thailand, Australia, Ireland, Japan, Canada, and England. Most recently I have been exploring models of care and caregiver practices in group homes for people with intellectual disability, in the US and Australia. This work has led to the development of educational interventions designed to facilitate cost effective, targeted development of staff skills, particularly for direct care workers.

Representative Publications
Roll, A. E., & Bowers, B. J. (2017). Promoting healthy aging of individuals with developmental disabilities: A qualitative case study. Western Journal of Nursing Research, 39(2), 234-251.
View publication via DOI: DOI:10.1177/0193945916668329

Xiao, H., Yoon, J. Y., & Bowers, B. J. (2017). Quality of life of nursing home residents in China: A mediation analysis. Nursing and Health Sciences, 19)2), 149-156.
View publication via DOI: DOI:10.1111/nhs.12288

Xao, H., Yoon, J., & Bowers, B. J. (2016). Living arrangement and quality of life: Mediation analysis by physical function and depression. Western Journal of Nursing Research, 38(6), 738-52.
View publication via DOI: DOI:10.1177/0193945915621260

Bowers, B. J., Nolet, K., & Jacobson, N. (2016). Sustaining culture change: Experiences in the Green House model. Health Services Research, 51(S1), 398-417.
View publication via DOI: DOI:10.1111/1475-6773.12428

Bowers, B. J., Roberts, T., & Nolet, K. (2016). Inside the Green House 'black box': Opportunities for high-quality clinical decision making. Health Services Research, 51(S1), 378-397.
View publication via DOI: DOI:10.1111/1475-6773.12427

Cohen, L., Zimmerman, S., Reed, D., Brown, P., Bowers, B. J., Nolet, K., Hudack, S., & Horn, S. (2016). The Green House Model of nursing home care in design and implementation. Health Services Research, 51(S1), 352-377.
View publication via DOI: DOI:10.1111/1475-6773.12418

Lor, M., Xiong, P., Schwei, P., Bowers, B. J., & Jacobs, E. (2016). Limited English proficient Hmong- and Spanish-speaking patients' perceptions of the quality of interpreter services. International Journal of Nursing Studies, 54, 75-83.
View publication via DOI: DOI:10.1016/j.ijnurstu.2015.03.019

McGilton, K., Bowers, B. J., Mueller, C., ... & Heath, H. (2016). Recommendations from the International Consortium on Professional Nursing Practice in Long Term Care Homes. Journal of Post-Acute and Long-Term Care Medicine, 17(2), 99-103.
View publication via DOI: DOI:10.1016/j.jamda.2015.11.001

Webber, R., Bowers, B. J., & Bigby, C. (2016). Confidence of group home staff in supporting the health needs of older residents with intellectual disability. Journal of Intellectual and Developmental Disability, 41(2), 107-114.
View publication via DOI: DOI:10.3109/13668250.2015.1130218

Yoon, J. Y., Brown, R. L., Bowers, B. J., Sharkey, S., & Horn, S. (2016). The effects of the Green House nursing home model on ADL function trajectory: A retrospective longitudinal study. International Journal of Nursing Studies, 53(1), 238-247.
View publication via DOI: DOI:10.1016/j.ijnurstu.2015.07.010

Bartels, C. M., Roberts, T. J., Hansen, K. E., Jacobs, E. A., Gilmore, A., Maxcy, C., & Bowers, B. J. (2016). Rheumatologist and primary care management of cardiovascular disease risk in rheumatoid arthritis: Patient and provider perspectives. Arthritis Care and Research, 68(4), 415-423.
View publication via DOI: DOI:10.1002/acr.22689

Jacobson, N., Krupp, A., & Bowers, B. J. (2016). Planning for ancillary care provision: Lessons from the developing world. Journal of Empirical Research on Human Research Ethics, 11(2), 129-134.
View publication via DOI: DOI:10.1177/1556264616637961

Johnson, H. M., Warner, R. C., LaMantia, J. N., & Bowers, B. J. (2016). "I have to live like I'm old." Young adults' perspectives on managing hypertension: A multi-center qualitative study. BMC Family Practice, 17(31), 1-9.
View publication via DOI: DOI:10.1186/s12875-016-0428-9

Xiao, H., Yoon, J. Y., & Bowers, B. J. (2016). Living arrangements and quality of life: Mediation by physical function and depression. Western Journal of Nursing Research, 38(6), 738-752.
View publication via DOI: DOI:10.1177/0193945915621260

Zimmerman, S., Bowers, B. J., Cohen, L. W., Grabowski, D. C., Horn, S. D., & Kemper, P. (2016). New evidence on the green house model of nursing home care: Synthesis of findings and implications for policy, practice, and research. Health Services Research, 51 Suppl 1, 475-496.
View publication via DOI: DOI:10.1111/1475-6773.12430

Chen, I. H., Brown, R. L., Bowers, B. J., & Chang, W.-Y. (2015). Job demand and job satisfaction in latent groups of turnover intention among licensed nurses in taiwan nursing homes. Nursing & Health, 38(5), 342-356.
View publication via DOI: DOI:10.1002/nur.21667

Chen, I.-H., Brown, R. L., Bowers, B. J., & Chang, W.-Y. (2015). Work-to-family conflict as a mediator of the relationship between job satisfaction and turnover intention. Journal of Advanced Nursing, 71(10), 2350-2365.
View publication via DOI: DOI:10.1111/jan.12706

Lee, G., Yoon, J. Y., & Bowers, B. J. (2015). Nursing home adjustment scale: A psychometric study of an English version. Quality of life Research, 24, 993-998.
View publication via DOI: DOI:10.1007/s11136-014-0836-z

Meulenbroek, P., Turkstra, L., & Bowers, B. J. (2015). Characterizing common workplace communication skills for disorders associated with traumatic brain injury: A qualitative study. Journal of Vocational Rehabilitation, 44, 15-31.
View publication via DOI: DOI:10.3233/JVR-150777#

Roberts, T., & Bowers, B. J. (2015). How nursing home residents develop relationships with peers and staff: A grounded theory study. International Journal of Nursing Studies, 52(1), 57-67.
View publication via DOI: DOI:10.1016/j.ijnurstu.2014.07.008

Roberts, T., Nolet, K., & Bowers, B. J. (2015). Consistent assignment of nursing staff to residents in nursing homes: A critical review of conceptual and methodological issues. The Gerontologist, 55(3), 434-447.
View publication via DOI: DOI:10.1093/geront/gnt101

Bowers, B. J., & Nolet, K. (2014). Developing the Green House nursing care team: Variations on development and implementation. The Gerontologist, 54(Suppl 1), S53-S64.
View publication via DOI: DOI:10.1093/geront/gnt109

Lor, M., & Bowers, B. J. (2014). Evaluating Teaching Techniques in the Hmong Breast and Cervical Cancer Health Awareness Project. Journal of Cancer Education, 29(2), 358-65.
View publication via DOI: DOI:10.1007/s13187-014-0615-0

McGilton, K. S., Boscart, V. M., Brown, M., & Bowers, B. (2014). Making tradeoffs between the reasons to leave and reasons to stay employed in long-term care homes: Perspectives of licensed nursing staff. International Journal of Nursing Studies, 51(6), 917-926.
View publication via DOI: DOI:10.1016/j.ijnurstu.2013.10.015

Sasat, S., & Bowers, B. (2013). Spotlight Thailand. The Gerontologist, 53(4), 711-717.
View publication via DOI: DOI:10.1093/geront/gnt038

Gilmore-Bykovskyi, A.L., & Bowers, B.J. (2013). Understanding nurses decisions to treat pain in nursing home residents with dementia. Research in Gerontological Nursing, 6(2), 127-138.
View publication via DOI: DOI:10.3928/19404921-20130110-02

Bowers, B. J. (2013). Evidence-based practice: Contributions and possibilities for qualitative research. In C. Tatano Beck (Ed.), Routledge International Handbook of Qualitative Nursing Research (pp. 405-416). New York: Routledge.

King, B., & Bowers, B. J. (2013). Attributing the responsibility for ambulating patients. International Journal of Nursing Studies, 50(9), 1240-6.
View publication via DOI: DOI:10.1016/j.ijnurstu.2013.02.007

Webber, R., Bowers, B. J., & Bigby, C. (2013). Residential aged care for people with intellectual disability: A matter of perspective. Australian Journal of Ageing. Advance online publication.
View publication via DOI: DOI:10.1111/ajag.12086

Wonsawang, N., Sunee, L., Lapvongwattana, P., & Bowers, B. (2013). Family Caregiving for Dependent Older Persons in Thai Families. Journal of Nursing Scholarship. Advance online publication.
View publication via DOI: DOI:10.1111/jnu.12035

Yeboah, C., Bowers, B., & Rolls, C. (2013). Culturally and linguistically diverse older adults relocating to residential aged care. Contemporary Nurse, 44(1), 50-61.
View publication via DOI: DOI:10.5172/conu.2013.44.1.50

King, B. J., Gilmore-Bykovskyi, A. L., Roiland, R. A., Polnaszek, B. E., Bowers, B. J., & Kind, A. J. H. (2013). The consequences of poor communication during transitions from hospital to skilled nursing facility: A qualitative study. Journal of the American Geriatrics Society, 61(7), 1095-1102.
View publication via DOI: DOI:10.1111/jgs.12328

Bowers, B., Cohen, L. W., Elliot, A. E., Grabowski, D. C., Fishman, N. W., Sharkey, S. S., . . . Kemper, P. (2013). Creating and supporting a mixed methods health services research team. Health Services Research, 48, 2157-2180.
View publication via DOI: DOI:10.1111/1475-6773.12118

Roberts, T. J., Nolet, K. A., & Bowers, B. J. (2013). Consistent assignment of nursing staff to residents in nursing homes: A critical review of conceptual and methodological issues. The Gerontologist. Advance online publication.
View publication via DOI: DOI:10.1093/geront/gnt101

King, B. J., Roberts, T. J., & Bowers, B. J. (2012). Nursing student attitudes toward and preferences for working with older adults. Gerontology & Geriatrics Education, 34(3), 272-291.
View publication via DOI: DOI:10.1080/02701960.2012.718012

Yoon, J. Y., Lee, J. Y., Bowers, B. J. & Zimmerman, D. R. (2012). The impact of organizational factors on the urinary incontinence care quality in long-term care hospitals: A longitudinal correlational study. International Journal of Nursing Studies, 49(12), 1544-51.
View publication via DOI: DOI:10.1016/j.ijnurstu.2012.07.011

Yoon, J., Roberts, T., Bowers, B. & Lee, J. (2012). A Review of Person-centered Care in Nursing Homes. Journal of the Korean Gerontological Society, 32(3), 729-745.

McGilton, K. S., Heath, H., Chu, C. H., Bostrom, A. M., Mueller, C., Boscart, V. M., . . . Bowers, B. (2012). Moving the agenda forward: a person-centred framework in long-term care. International Journal of Older People Nursing 7, 303-309.
View publication via DOI: DOI:10.1111/opn.12010

Krause, M., Palmer, J., Bowers, B., & Buckwalter, K. (2011). Responding to poor quality care during research in nursing homes. Research in Gerontological Nursing, 4(1), 47-52.
View publication via DOI: DOI:10.3928/19404921-20100504-04

Bowers, B., & Nolet, K. (2011). Empowering Direct Care Workers: Lessons Learned from the GREEN HOUSE® Model. Senior Housing and Care Journal, 109-120.

King, B., & Bowers, B. (2011). How Nurses Decide to Ambulate Hospitalized Older Adults: Development of a Conceptual Model. The Gerontologist, 51(6), 786-797.
View publication via DOI: DOI:10.1093/geront/gnr044

Harahan, M.F., Bowers, B.J., Stone, R., Nolet, K.A., Sanders, A., Krause, M.R., & Gilmore, A. (2011). Implementation and evaluation of LVN LEAD: A leadership and supervisory training program for nursing home charge nurses. Journal of Gerontological Nursing, 37(6), 26-33.
View publication via DOI: DOI:10.3928/00989134-20110302-01

Bowers, B. (2011). Guest Editorial: Culture change - challenges, opportunities and questions. International Journal of Older People Nursing, 6(1), 3.
View publication via DOI: DOI:10.1111/j.1748-3743.2010.00267.x

Bowers, B.J. (2011). Nurse Residency Program Hopes to Attract New RNs to Long-term Care. Leader to Leader, the National Council of State Boards of Nursing Newsletter. Retrieved from: https://www.ncsbn.org/L2L_Spring2011.pdf.

Bigby, C., Bowers, B., & Webber, R. (2010). Planning and decision making about the future care of older group home residents and transition to residential aged care. Journal of Intellectual Disability Research, 5(8), 777-789.
Click here to download this publication.
View publication via DOI: DOI:10.1111/j.1365-2788.2010.01297.x

Webber, R., Bowers, B., & McKenzie-Green, B. (2010). Staff responses to age-related health changes in people with an intellectual disability in group homes. Disability & Society, 25(6), 657 - 671.
Click here to download this publication.
View publication via DOI: DOI:10.1080/09687599.2010.505736

Webber, R., Bowers, B., & Bigby, C. (2010). Hospital experiences of older people with intellectual disability: Responses of group home staff and family members. Journal of Intellectual & Developmental Disability, 35(3), 155-164.
View publication via DOI: DOI:10.3109/13668250.2010.491071

Baik, S., Gonzalez, J., Bowers, B., Anthony, J., Tidjani, B., & Susman, J. (2010). Reinvention of Depression Instruments by Primary Care Clinicians. Annals of Family Medicine. 8(3), 224-230.
View publication via DOI: DOI:10.1370/afm.1113

Bowers, B.J. (2010). Commentary 2: The perils of "success": maintaining the richness and diversity of qualitative scholarship. Qualitative Health Research, 20(11), 1465-6.
View publication via DOI: DOI:10.1177/1049732310379118

Anthony, J., Baik, S., Bowers, B., Tidjani, B., Jacobson, J., & Sussman, J. (2010). Conditions that influence the primary care clinicians' decision to refer patients for depression care. Rehabilitation Nursing, 35(3), 113-122.
View publication via DOI: DOI:10.1002/j.2048-7940.2010.tb00286.x

McGilton, K., Bowers, B., McKenzie-Green, B., Boscart, V., & Brown, M. (2009). How Do Charge Nurses View Their Roles in Long-Term Care? Journal of Applied Gerontology, 28, 723-742.
View publication via DOI: DOI:10.1177/0733464809336088

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.
Click here to download this publication.
View publication via DOI: DOI:10.1002/nur.20309

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.
View publication via DOI: DOI:10.1111/j.1365-2788.2007.01040.x

Downs, M., & Bowers, B. (2008). Caring for people with dementia [Editorial]. British Medical Journal, 336, 225-226.
View publication via DOI: DOI:10.1136/bmj.39429.434907.80

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.
View publication via DOI: DOI:10.1111/j.1532-5415.2006.00654.x

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.
View publication via DOI: DOI:10.1111/j.1532-5415.2005.53556.x

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.
View publication via DOI: DOI:10.1002/j.2048-7940.2003.tb02037.x

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.
View publication via DOI: DOI:10.1080/0968759032000080995

Caron, C.D., & Bowers, B.J. (2003). Deciding whether to continue, share or relinquish caregiving: Caregiver views. Qualitative Health Research, 13(9), 1252-71.
View publication via DOI: DOI:10.1177/1049732303257236

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.
View publication via DOI: DOI:10.1002/nur.10044

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.
View publication via DOI: DOI:10.1046/j.1365-2648.2001.01686.x

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.
View publication via DOI: DOI:10.1093/geront/41.4.539

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.
View publication via DOI: DOI:10.1093/geront/32.3.360

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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