• Safety and Health at Work
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• v.9 no.4
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• pp.408-415
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• 2018

Background: Nursing home resident care is an ongoing topic of public discussion, and there is great interest in improving the quality of resident care. This study investigated the association between nursing home employees' job satisfaction and residents' satisfaction with care and medical outcomes. Methods: Employee and resident satisfaction were measured by questionnaire in 175 skilled nursing facilities in the eastern United States from 2005 to 2009. Facility-level data on residents' pressure ulcers, medically unexplained weight loss, and falls were obtained from the Centers for Medicare and Medicaid Services Long-Term Care Minimum Data Set. The association between employee satisfaction and resident satisfaction was examined with multiple and multilevel linear regression. Associations between employee satisfaction and the rates of pressure ulcers, weight loss, and falls were examined with simple and multilevel Poisson regression. Results: A 1-point increase in overall employee satisfaction was associated with an increase of 17.4 points (scale 0-100) in the satisfaction of residents and family members (p < 0.0001) and a 19% decrease in the incidence of resident falls, weight loss, and pressure ulcers combined (p < 0.0001), after adjusting for staffing ratio and percentage of resident-days paid by Medicaid. Conclusion: Job satisfaction of nursing home employees is associated with lower rates of resident injuries and higher resident satisfaction with care. A supportive work environment may help increase quality of care in the nation's nursing homes.

• Lingua Humanitatis
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• v.8
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• pp.313-329
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• 2006

In some American English dialects, the vowels /a:/ or /c:/ have been replaced with /a:/, as in caught /ka:t/ dog /da:g/ that were pronounced in /kc:t/, and /dc:g/ previously. General American does not have /a:/ in its vowel system. But in East American and Western Pensylvania, cot and caught are homophones, /ka:t/, and similarly with other pairs such as collar vs. caller, stock vs. stalk, don vs. down, knotty vs. naughty. The use of /a/ or /c/ is quite unstable, and is a well-known diagnostic for distinguishing the northern speech area of the United States from the midland and southern area. For an increasing number of Americans, however, entirely lack the opposition between /a/ and /c/, merging to /a/, referring to 'both' of the vowels of lot. This paper investigates the use of /b:/ in American dialects and its relationship with /a:/, /c:/ in AE, and with short /a/ in RP. Examining the isoglosses of the use of /a:/ in various databases of the phonological atlas of North America, this paper discusses the use, position, and trend of merger to /a:/ from the vowels of /a:/ and /c:/ in Current American English.