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Spilsbury K, Charlwood A, Thompson C, Haunch K, Valizade D, Devi R, Jackson C, Alldred DP, Arthur A, Brown L, Edwards P, Fenton W, Gage H, Glover M, Hanratty B, Meyer J, Waton A. Relationship between staff and quality of care in care homes: StaRQ mixed methods study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-139. [PMID: 38634535 DOI: 10.3310/gwtt8143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background Quality of life and care varies between and within the care homes in which almost half a million older people live and over half a million direct care staff (registered nurses and care assistants) work. The reasons are complex, understudied and sometimes oversimplified, but staff and their work are a significant influence. Objective(s) To explore variations in the care home nursing and support workforce; how resident and relatives' needs in care homes are linked to care home staffing; how different staffing models impact on care quality, outcomes and costs; how workforce numbers, skill mix and stability meet residents' needs; the contributions of the care home workforce to enhancing quality of care; staff relationships as a platform for implementation by providers. Design Mixed-method (QUAL-QUANT) parallel design with five work packages. WP1 - two evidence syntheses (one realist); WP2 - cross-sectional survey of routine staffing and rated quality from care home regulator; WP3 - analysis of longitudinal data from a corporate provider of staffing characteristics and quality indicators, including safety; WP4 - secondary analysis of care home regulator reports; WP5 - social network analysis of networks likely to influence quality innovation. We expressed our synthesised findings as a logic model. Setting English care homes, with and without nursing, with various ownership structures, size and location, with varying quality ratings. Participants Managers, residents, families and care home staff. Findings Staffing's contribution to quality and personalised care requires: managerial and staff stability and consistency; sufficient staff to develop 'familial' relationships between staff and residents, and staff-staff reciprocity, 'knowing' residents, and skills and competence training beyond induction; supported, well-led staff seeing modelled behaviours from supervisors; autonomy to act. Outcome measures that capture the relationship between staffing and quality include: the extent to which resident needs and preferences are met and culturally appropriate; resident and family satisfaction; extent of residents living with purpose; safe care (including clinical outcomes); staff well-being and job satisfaction were important, but underacknowledged. Limitations Many of our findings stem from self-reported and routine data with known biases - such as under reporting of adverse incidents; our analysis may reflect these biases. COVID-19 required adapting our original protocol to make it feasible. Consequently, the effects of the pandemic are reflected in our research methods and findings. Our findings are based on data from a single care home operator and so may not be generalised to the wider population of care homes. Conclusions Innovative and multiple methods and theory can successfully highlight the nuanced relationship between staffing and quality in care homes. Modifiable characteristics such as visible philosophies of care and high-quality training, reinforced by behavioural and relational role modelling by leaders can make the difference when sufficient amounts of consistent staff are employed. Greater staffing capacity alone is unlikely to enhance quality in a cost-effective manner. Social network analysis can help identify the right people to aid adoption and spread of quality and innovation. Future research should focus on richer, iterative, evaluative testing and development of our logic model using theoretically and empirically defensible - rather than available - inputs and outcomes. Study registration This study is registered as PROSPERO CRD42021241066 and Research Registry registration: 1062. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 15/144/29) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 8. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
| | - Andy Charlwood
- Leeds University Business School, University of Leeds, Leeds, UK
| | - Carl Thompson
- School of Healthcare, University of Leeds, Leeds, UK
| | - Kirsty Haunch
- School of Healthcare, University of Leeds, Leeds, UK
| | - Danat Valizade
- Leeds University Business School, University of Leeds, Leeds, UK
| | - Reena Devi
- School of Healthcare, University of Leeds, Leeds, UK
| | | | | | - Antony Arthur
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Lucy Brown
- The Florence Nightingale Foundation, London, UK
| | | | | | - Heather Gage
- School of Biosciences and Medicine, University of Surrey, Surrey, UK
| | - Matthew Glover
- School of Biosciences and Medicine, University of Surrey, Surrey, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Julienne Meyer
- School of Health Sciences, City University of London, London, UK
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Haunch K, Thompson C, Arthur A, Edwards P, Goodman C, Hanratty B, Meyer J, Charlwood A, Valizade D, Backhaus R, Verbeek H, Hamers J, Spilsbury K. Understanding the staff behaviours that promote quality for older people living in long term care facilities: A realist review. Int J Nurs Stud 2021; 117:103905. [PMID: 33714766 DOI: 10.1016/j.ijnurstu.2021.103905] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Little is known about how the workforce influences quality in long term care facilities for older people. Staff numbers are important but do not fully explain this relationship. OBJECTIVES To develop theoretical explanations for the relationship between long-term care facility staffing and quality of care as experienced by residents. DESIGN A realist evidence synthesis to understand staff behaviours that promote quality of care for older people living in long-term care facilities. SETTING Long-term residential care facilities PARTICIPANTS: Long-term care facility staff, residents, and relatives METHODS: The realist review, (i) was co-developed with stakeholders to determine initial programme theories, (ii) systematically searched the evidence to test and develop theoretical propositions, and (iii) validated and refined emergent theory with stakeholder groups. RESULTS 66 research papers were included in the review. Three key findings explain the relationship between staffing and quality: (i) quality is influenced by staff behaviours; (ii) behaviours are contingent on relationships nurtured by long-term care facility environment and culture; and (iii) leadership has an important influence on how organisational resources (sufficient staff effectively deployed, with the knowledge, expertise and skills required to meet residents' needs) are used to generate and sustain quality-promoting relationships. Six theoretical propositions explain these findings. CONCLUSION Leaders (at all levels) through their role-modelling behaviours can use organisational resources to endorse and encourage relationships (at all levels) between staff, residents, co-workers and family (relationship centred care) that constitute learning opportunities for staff, and encourage quality as experienced by residents and families.
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Affiliation(s)
- Kirsty Haunch
- School of Healthcare, Faculty of Medicine and Health, Baines Wing (Room 2,28), University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Carl Thompson
- School of Healthcare, Faculty of Medicine and Health, Baines Wing (Room 2,28), University of Leeds, Leeds LS2 9JT, United Kingdom; NIHR ARC Yorkshire and Humber
| | - Antony Arthur
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | | | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, Hertfordshire, United Kingdom; NIHR ARC East of England
| | - Barbara Hanratty
- Population Health Sciences Institute, University of Newcastle, United Kingdom; NIHR ARC North East and North Cumbria
| | - Julienne Meyer
- School of Health Sciences, City, University of London, United Kingdom
| | - Andy Charlwood
- School of Healthcare, Faculty of Medicine and Health, Baines Wing (Room 2,28), University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Danat Valizade
- School of Healthcare, Faculty of Medicine and Health, Baines Wing (Room 2,28), University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Ramona Backhaus
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Jan Hamers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Karen Spilsbury
- School of Healthcare, Faculty of Medicine and Health, Baines Wing (Room 2,28), University of Leeds, Leeds LS2 9JT, United Kingdom; NIHR ARC Yorkshire and Humber.
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Managerial Strategies for Long-Term Care Organization Professionals: COVID-19 Pandemic Impacts. SUSTAINABILITY 2020. [DOI: 10.3390/su12229682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper aims to analyze the strategies that healthcare professionals have adopted during the coronavirus pandemic (COVID-19) in long-term care organizations in Rio de Janeiro city, Brazil, by investigating their competencies—mainly managerial ones. To reach its goals, this paper performs empirical research and theoretical research. For the empirical research, the plans of professionals during COVID-19 pandemic in long-term care organizations are observed, and a questionnaire is applied to analyze observed data integrity. The data are analyzed through the Python and IBM SPSS Statistic programming languages, and descriptive analyses use descriptive statistic proportions, rates, minimum, maximum, mean, median, standard deviation, and coefficient of variation (CV). A non-parametric approach performs repeated measure comparisons using Wilcoxon’s test, while the McNemmar test is used to repeat the categorical variables. Statistical significance is assumed at the 5% level. For the theoretical research, a literature review is developed using scientific databases. The results show that for the searched period, the number of deaths and the number of people infected by COVID-19 in these organizations are low when compared to general statistics of Rio de Janeiro city. This paper concludes that these strategical adoptions have brought significant benefits to long-term care organizations, and it might motivate researchers to develop future studies related to long-term care organizations, helping to fill the literature gap on the subject.
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Gershater MA, Apelqvist J. Elderly individuals with diabetes and foot ulcer have a probability for healing despite extensive comorbidity and dependency. Expert Rev Pharmacoecon Outcomes Res 2020; 21:277-284. [PMID: 32448021 DOI: 10.1080/14737167.2020.1773804] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Limited scientific evidence for prevention and treatment of diabetic foot ulcers in elderly with comorbidities. AIM To explore patient-related factors and outcomes in patients ≥75 years with diabetes and a foot ulcer. METHOD Sub-analysis of consecutively presenting patients ≥75 years (N = 1008) from a previous study on 2,480 patients with diabetic foot ulcer treated in a multidisciplinary system until healing. Patient characteristics: age - 81(75-96); diabetes type 2-98.7%; male/female - 49/51%; living with a spouse - 47%; nursing home 16%; or with home nursing 64%. RESULT Primary healing was achieved in 54%, minor amputation 8%, major amputation 9%, auto-amputation 2%, and 26% of the patients died unhealed. Among the oldest (88-96 years), 31% healed without any amputation. Extensive comorbidities were frequent: neuropathy 93%, visual impairment 73%, cardiovascular disease 60%, cerebrovascular disease 34%, and severe peripheral disease in 29% of the patients. Out of patients (80%) living in institutions or dependent on home nursing, 56% healed without amputation, compared to 44% of patients living in their own home without any support from social services or home nursing. CONCLUSION Healing without major amputation was achieved in 84% of surviving patients ≥75 years, despite extensive comorbidity and dependency.
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Affiliation(s)
| | - Jan Apelqvist
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
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Singh J, Wiese A, Sillerud B. Using Phenomenological Hermeneutics to Understand the Experiences of Managers Working with Quality Improvement Strategies in an Assisted Living Facility. Healthcare (Basel) 2019; 7:E87. [PMID: 31284684 PMCID: PMC6787700 DOI: 10.3390/healthcare7030087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 06/28/2019] [Accepted: 07/03/2019] [Indexed: 11/19/2022] Open
Abstract
This qualitative research project aimed to gain an understanding of the experiences of managers who participated in the implementation of quality improvement projects in an assisted living facility. This study employed hermeneutic phenomenology as a research methodology, whereby managers working in an assisted living facility were invited to participate in a 60-75 min semi-structured interview. Six managers participated in the interviews. Five themes were developed from data analysis: (1) Quality improvement (QI) and resident-centered care go hand-in-hand; (2) Constant on-going commitment to continuous improvement is needed to implement QI; (3) Learning to communicate with team-members and residents/caregivers is important to implement QI; (4) Feedback is essential for the implementation of QI initiatives; and (5) Implementing new QI initiatives can be challenging. The managers emphasized the need for leadership commitment, the usage of standardized communication methods, and feedback strategies to ensure the success of QI initiatives. Additionally, the managers indicated that QI is directly related to resident-centered care and that efforts should be made to collect feedback from residents to further improve processes. Additionally, challenges surrounding the implementation of QI have been described. Since there is a scarcity of research on the implementation of QI methods in assisted living facilities, this study can provide practical tips to leaders and administrators.
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Affiliation(s)
- Jitendra Singh
- School of Nursing & Healthcare Leadership, College of Science, Health & the Environment, Minnesota State University Moorhead, Moorhead, MN 56563, USA.
| | - Amy Wiese
- School of Nursing & Healthcare Leadership, College of Science, Health & the Environment, Minnesota State University Moorhead, Moorhead, MN 56563, USA
| | - Brandi Sillerud
- School of Nursing & Healthcare Leadership, College of Science, Health & the Environment, Minnesota State University Moorhead, Moorhead, MN 56563, USA
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Søreide H, Kyrkjebø D, Råholm M. Challenges in municipality healthcare services-The nurse leaders' perspective. Nurs Open 2019; 6:889-896. [PMID: 31367412 PMCID: PMC6650667 DOI: 10.1002/nop2.270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/01/2019] [Accepted: 02/27/2019] [Indexed: 12/04/2022] Open
Abstract
AIM To examine perceptions of key challenges that nursing leadership face when organizing healthcare services in the municipality. DESIGN A qualitative study involving community nurse leaders (N = 9) in two focus group interviews. METHODS The material has been processed and interpreted in accordance with the phenomenological-hermeneutical tradition, and this process was inspired by Graneheim and Lundman. RESULTS Three themes were identified in this study: (a) Tension between organizing the daily work and future challenges; (b) Challenges with recruiting enough registered nurse (RNs) in municipal healthcare services; and (c) Competence development plan-a strategic tool for nursing leadership. The municipal healthcare services need a better knowledge base with better knowledge of both the content and quality of services, organization, leadership and management, thus improving new forms of work and professional approaches.
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Affiliation(s)
- Hilde Søreide
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesFordeNorway
| | - Dagrun Kyrkjebø
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesFordeNorway
| | - Maj‐Britt Råholm
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesFordeNorway
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Moniz-Cook E, Hart C, Woods B, Whitaker C, James I, Russell I, Edwards RT, Hilton A, Orrell M, Campion P, Stokes G, Jones RSP, Bird M, Poland F, Manthorpe J. Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05150] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BackgroundDementia with challenging behaviour (CB) causes significant distress for caregivers and the person with dementia. It is associated with breakdown of care at home and disruption in care homes. Challenge Demcare aimed to assist care home staff and mental health practitioners who support families at home to respond effectively to CB.ObjectivesTo study the management of CB in care homes (ResCare) and in family care (FamCare). Following a conceptual overview, two systematic reviews and scrutiny of clinical guidelines, we (1) developed and tested a computerised intervention; (2) conducted a cluster randomised trial (CRT) of the intervention for dementia with CB in care homes; (3) conducted a process evaluation of implementation of the intervention; and (4) conducted a longitudinal observational cohort study of the management of people with dementia with CB living at home, and their carers.Review methodsCochrane review of randomised controlled trials; systematic meta-ethnographic review of quantitative and qualitative studies.DesignResCare – survey, CRT, process evaluation and stakeholder consultations. FamCare – survey, longitudinal cohort study, participatory development design process and stakeholder consultations. Comparative examination of baseline levels of CB in the ResCare trial and the FamCare study participants.SettingsResCare – 63 care homes in Yorkshire. FamCare – 33 community mental health teams for older people (CMHTsOP) in seven NHS organisations across England.ParticipantsResCare – 2386 residents and 861 staff screened for eligibility; 555 residents with dementia and CB; 277 ‘other’ residents; 632 care staff; and 92 staff champions. FamCare – every new referral (n = 5360) reviewed for eligibility; 157 patients with dementia and CB, with their carer; and 26 mental health practitioners. Stakeholder consultations – initial workshops with 83 practitioners and managers from participating organisations; and 70 additional stakeholders using eight group discussions and nine individual interviews.InterventionAn online application for case-specific action plans to reduce CB in dementia, consisting of e-learning and bespoke decision support care home and family care e-tools.Main outcome measuresResCare – survey with the Challenging Behaviour Scale; measurement of CB with the Neuropsychiatric Inventory (NPI) and medications taken from prescriptions; implementation with thematic views from participants and stakeholders. FamCare – case identification from all referrals to CMHTsOP; measurement of CB with the Revised Memory and Behaviour Problems Checklist and NPI; medications taken from prescriptions; and thematic views from stakeholders. Costs of care calculated for both settings. Comparison of the ResCare trial and FamCare study participants used the NPI, Clinical Dementia Rating and prescribed medications.ResultsResCare – training with group discussion and decision support for individualised interventions did not change practice enough to have an impact on CB in dementia. Worksite e-learning opportunities were not readily taken up by care home staff. Smaller homes with a less hierarchical management appear more ready than others to engage in innovation. FamCare – home-dwelling people with dementia and CB are referred to specialist NHS services, but treatment over 6 months, averaging nine contacts per family, had no overall impact on CB. Over 60% of people with CB had mild dementia. Families bear the majority of the care costs of dementia with CB. A care gap in the delivery of post-diagnostic help for families supporting relatives with dementia and significant CB at home has emerged. Higher levels of CB were recorded in family settings; and prescribing practices were suboptimal in both care home and family settings.LimitationsFunctionality of the software was unreliable, resulting in delays. This compromised the feasibility studies and undermined delivery of the intervention in care homes. A planned FamCare CRT could not proceed because of insufficient referrals.ConclusionsA Cochrane review of individualised functional analysis-based interventions suggests that these show promise, although delivery requires a trained dementia care workforce. Like many staff training interventions, our interactive e-learning course was well received by staff when delivered in groups with facilitated discussion. Our e-learning and decision support e-tool intervention in care homes, in its current form, without ongoing review of implementation of recommended action plans, is not effective at reducing CB when compared with usual care. This may also be true for staff training in general. A shift in priorities from early diagnosis to early recognition of dementia with clinically significant CB could bridge the emerging gap and inequities of care to families. Formalised service improvements in the NHS, to co-ordinate such interventions, may stimulate better opportunities for practice models and pathways. Separate services for care homes and family care may enhance the efficiency of delivery and the quality of research on implementation into routine care.Future workThere is scope for extending functional analysis-based interventions with communication and interaction training for carers. Our clinical workbooks, video material of real-life episodes of CB and process evaluation tool resources require further testing. There is an urgent need for evaluation of interventions for home-dwelling people with dementia with clinically significant CB, delivered by trained dementia practitioners. Realist evaluation designs may illuminate how the intervention might work, and for whom, within varying service contexts.Trial registrationCurrent Controlled Trials ISRCTN02553381 (the ResCare trial) and ISRCTN58876649 (the FamCare study).FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Esme Moniz-Cook
- Faculty of Health Sciences, University of Hull, Hull, UK
- Research and Development, Humber NHS Foundation Trust, Hull and East Yorkshire, UK
| | - Cathryn Hart
- Research and Development, Humber NHS Foundation Trust, Hull and East Yorkshire, UK
| | - Bob Woods
- Dementia Services Development Centre, Bangor University, Bangor, UK
| | - Chris Whitaker
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | - Ian James
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ian Russell
- Swansea Trials Unit, Swansea University, Swansea, UK
| | | | - Andrea Hilton
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Martin Orrell
- Institute of Mental Health, The University of Nottingham, Nottingham, UK
| | - Peter Campion
- Faculty of Health Sciences, University of Hull, Hull, UK
| | | | - Robert SP Jones
- North Wales Clinical Psychology Programme, Bangor University, Bangor, UK
| | - Mike Bird
- Dementia Services Development Centre, Bangor University, Bangor, UK
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King’s College London, London, UK
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Hoben M, Norton PG, Ginsburg LR, Anderson RA, Cummings GG, Lanham HJ, Squires JE, Taylor D, Wagg AS, Estabrooks CA. Improving Nursing Home Care through Feedback On PerfoRMance Data (INFORM): Protocol for a cluster-randomized trial. Trials 2017; 18:9. [PMID: 28069045 PMCID: PMC5223357 DOI: 10.1186/s13063-016-1748-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 12/08/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Audit and feedback is effective in improving the quality of care. However, methods and results of international studies are heterogeneous, and studies have been criticized for a lack of systematic use of theory. In TREC (Translating Research in Elder Care), a longitudinal health services research program, we collect comprehensive data from care providers and residents in Canadian nursing homes to improve quality of care and life of residents, and quality of worklife of caregivers. The study aims are to a) systematically feed back TREC research data to nursing home care units, and b) compare the effectiveness of three different theory-based feedback strategies in improving performance within care units. METHODS INFORM (Improving Nursing Home Care through Feedback On PerfoRMance Data) is a 3.5-year pragmatic, three-arm, parallel, cluster-randomized trial. We will randomize 67 Western Canadian nursing homes with 203 care units to the three study arms, a standard feedback strategy and two assisted and goal-directed feedback strategies. Interventions will target care unit managerial teams. They are based on theory and evidence related to audit and feedback, goal setting, complex adaptive systems, and empirical work on feeding back research results. The primary outcome is the increased number of formal interactions (e.g., resident rounds or family conferences) involving care aides - non-registered caregivers providing up to 80% of direct care. Secondary outcomes are a) other modifiable features of care unit context (improved feedback, social capital, slack time) b) care aides' quality of worklife (improved psychological empowerment, job satisfaction), c) more use of best practices, and d) resident outcomes based on the Resident Assessment Instrument - Minimum Data Set 2.0. Outcomes will be assessed at baseline, immediately after the 12-month intervention period, and 18 months post intervention. DISCUSSION INFORM is the first study to systematically assess the effectiveness of different strategies to feed back research data to nursing home care units in order to improve their performance. Results of this study will enable development of a practical, sustainable, effective, and cost-effective feedback strategy for routine use by managers, policy makers and researchers. The results may also be generalizable to care settings other than nursing homes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02695836 . Date of registration: 24 February 2016.
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Affiliation(s)
- Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta Canada
- Alberta Innovates-Health Solutions (AIHS) post-doctoral fellow, Translating Research in Elder Care (TREC), Faculty of Nursing, University of Alberta, 5-006 Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Peter G. Norton
- Department of Family Medicine, University of Calgary, Cumming School of Medicine, Calgary, Alberta Canada
| | - Liane R. Ginsburg
- Faculty of Health, York University, School of Health Policy and Management, Toronto, Ontario Canada
| | - Ruth A. Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina USA
| | | | - Holly J. Lanham
- Department of Medicine and Department of Family and Community Medicine, University of Texas, Health Science Center San Antonio, San Antonio, Texas USA
| | | | - Deanne Taylor
- Interior Health Authority, Kelowna, British Columbia Canada
| | - Adrian S. Wagg
- Faculty of Medicine and Dentistry, University of Alberta, Division of Geriatric Medicine, Edmonton, Alberta Canada
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Kristiansen M, Westeren KI, Obstfelder A, Lotherington AT. Coping with increased managerial tasks: tensions and dilemmas in nursing leadership. J Res Nurs 2016. [DOI: 10.1177/1744987116668940] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The present study explores how increased managerial tasks affect nursing leadership in Norwegian nursing homes. Responding to New Public Management reforms, increased managerial tasks have been implemented by Norwegian central government into public nursing homes. Even though nursing leadership plays a key role in implementing managerial tasks, it is still unclear how nurses describe the influence of increased managerial tasks in nursing leadership. This was a qualitative study, including 100 hours of observations and 18 semi-structured interviews of nurses holding various positions in three public nursing homes. Thematic analysis was used in analysing data. Three changes were identified in the exercise of nursing leadership: (1) leading daily care from a distance; (2) lack of support in problem-solving; and (3) difficulties in adopting new managerial language. The study demonstrates that managers take on a more administrative role that, in turn, weakens their ability to supervise and motivate nurses in daily care. Lack of a reciprocal relationship between managers and nurses in goal achievement has significantly weakened nursing leadership in nursing homes. The study contributes knowledge on how nursing leadership weakens as a response to changes in nurses’ roles with increased managerial tasks.
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Affiliation(s)
- Margrethe Kristiansen
- PhD Student, Department of Health and Care Sciences, University of Tromsø (UiT) – The Arctic University of Norway, Norway
| | - Knut Ingar Westeren
- Professor in Leadership, Department of Economics, Organisation and Leadership, Nord-Trøndelag University College, Norway
| | - Aud Obstfelder
- Professor in Sociological Theory, Department of Health and Care Sciences, UiT – The Arctic University of Norway, Norway
| | - Ann Therese Lotherington
- Professor and Head of Department, Centre for Gender- and Women’s Research, UiT – The Arctic University of Norway, Norway
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A qualitative study exploring visible components of organizational culture: what influences the use of psychotropic medicines in nursing homes? Int Psychogeriatr 2016; 28:1725-35. [PMID: 27189383 DOI: 10.1017/s1041610216000715] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The influence of organizational culture on how psychotropic medicines are used in nursing homes has not been extensively studied. Schein's theory provides a framework for examining organizational culture which begins with the exploration of visible components of an organization such as behaviors, structures, and processes. This study aimed to identify key visible components related to the use of psychotropic medicines in nursing homes. METHODS A qualitative study was conducted in eight nursing homes in Sydney, Australia. Purposive sampling was used to conduct semi-structured interviews with 40 participants representing a broad range of health disciplines. Thematic analysis was used to derive concepts. RESULTS Three visible components were related to psychotropic medicine use. These were drugs and therapeutics committee meetings, pharmacist led medication management reviews and formal and informal meetings with residents and their families. We found that only a few nursing homes utilized drugs and therapeutics committee meetings to address the overuse of psychotropic medicines. Pharmacist led medication management reviews provided a lever to minimize inappropriate psychotropic prescribing for a number of nursing homes; however, in others it was used as a box-ticking exercise. We also found that some nursing homes used meetings with residents and their families to review the use of psychotropic medicines. CONCLUSION This study was the first to illustrate that visible components of organizational culture do influence the use of psychotropic medicines and explains in detail what of the culture needs to be addressed to reduce inappropriate psychotropic prescribing.
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Annersten Gershater M, Pilhammar E, Alm Roijer C. Prevention of foot ulcers in patients with diabetes in home nursing: a qualitative interview study. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
RÉSUMÉLes maisons de soins infirmiers sont devenues des environnements offrant des soins complexes, dont les habitants ont des besoins importants et la plupart souffrent de la démence liée a l’âge. S’appuyant sur les recherches de Hirdes et al. (2011), nous décrivons un profil des résidents dans un échantillon représentatif de 30 maisons de soins infirmiers en milieu urbain dans les provinces des Prairies, en utilisant des données de L’Instrument d’évaluation des résidents/le recueil de données minimum (Resident Assistant Instrument – Minimum Data Set 2.0) de 5 196 évaluations résidents accomplies entre le 1ier octobre et le 31ieme décembre 3011. Les résidents avaient principalement plus de 85 ans, étaient des femmes, et souffraient d’une démence liée à l’âge. Nous avons comparé le soutien et les services connexes des établissements et les caractéristiques des résidents par province, par les modèles du propriétaire-gérant, et par le nombre d’unités dans une installation. Nous avons également constaté que les établissements publics ont tendance à s’occuper des résidents ayant des caractéristiques plus exigeants : notamment, la déficience cognitive, un comportement aggressif, et l’incontinence. Aucune tendance claire n’a été observée reliant le nombre d’unités dans un établissement aux caractéristiques des résidents.
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Kokkonen K, Rissanen S, Hujala A. The match between institutional elderly care management research and management challenges - a systematic literature review. Health Res Policy Syst 2012; 10:35. [PMID: 23137416 PMCID: PMC3542075 DOI: 10.1186/1478-4505-10-35] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 10/29/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Elderly care practice and its management together with policy and research play a crucial role in responding to increasing challenges in institutional care for elderly people. Successful dialogue between these is necessary. The purpose of this systematic literature review is to compare how institutional elderly care management research meets the care challenges currently emphasized in international long-term care policy documents. METHODS This paper was based on a systematic literature review. After screening 1971 abstracts using inclusion/exclusion criteria, 58 refereed articles published between 2000 and 2010 remained for analysis. The articles were analyzed using theory-based content analysis by comparing the results to the framework based on analysis of international long-term care management policy documents. RESULTS The current challenges of long-term care management identified from policy documents were Integrated Care Management, Productivity Management, Quality Management, Workforce Management and ICT Management. The research on institutional elderly care management responded somewhat to the challenges mentioned in policy documents. However, some of the challenges were studied broadly and some were paid only minor attention. Further, only few studies focused on the core items of challenges addressed in policy documents. CONCLUSIONS Institutional care management research needs to focus more on challenges in integrated care, productivity, ICT and division of labor. Managers, researchers and policy-makers should assume more active collaborative roles in processes of research, policymaking and policy implementation. In addition managers' and policymakers' scientific literacy needs to be enhanced.
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Affiliation(s)
- Kaija Kokkonen
- Department of Health and Social Management, University of Eastern Finland, Kuopio Campus, P.O. BOX 1627, Kuopio, FI, 70211, Finland
| | - Sari Rissanen
- Department of Social Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anneli Hujala
- Department of Health and Social Management, University of Eastern Finland, Kuopio Campus, P.O. BOX 1627, Kuopio, FI, 70211, Finland
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GJEVJON EDITHR, ROMØREN TORI, KJØS BENTEØ, HELLESØ RAGNHILD. Continuity of care in home health-care practice: two management paradoxes. J Nurs Manag 2012; 21:182-90. [DOI: 10.1111/j.1365-2834.2012.01366.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lin J, Hsiao CT, Glen R, Pai JY, Zeng SH. Perceived service quality, perceived value, overall satisfaction and happiness of outlook for long-term care institution residents. Health Expect 2012; 17:311-20. [PMID: 22429448 DOI: 10.1111/j.1369-7625.2012.00769.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To investigate the psychometric properties and relationships of perceived service quality, perceived value and overall satisfaction for residents with respect to their long-term care institutions. DESIGN The five-point Likert scale questionnaire administered through facetoface interviews. SETTING Fourteen long-term care institutions located in central and southern Taiwan stratified according to services and accommodation population. PARTICIPANTS One hundred and eighty long-term institutional care residents. MAIN OUTCOME MEASURES Perceived service quality (the SERVPERF model), perceived value and overall satisfaction (models based on the literature on perceived value and satisfaction). RESULTS Student's t-test on institutional location shows a significant difference between overall satisfaction for central and southern institution long-term care recipients. The correlation test revealed that the higher a resident's level of education, the higher the scores for perceived value. The factor loading results of confirmation factor analysis show acceptable levels of reliability and index-of-model fits for perceived service, perceived value and overall satisfaction. In addition, the results suggest that an additional construct, a positive attitude (happiness of outlook) towards long-term care institutions, is also an important factor in residents' overall satisfaction. CONCLUSION The primary goal of long-term institutional care policy in Taiwan, as in other countries, is to provide residents with practical, cost-effective but high-quality care. On the basis of the results of in-depth interviews with long-term institutional care residents, this study suggests long-term care institutions arrange more family visit days to increase the accessibility and interaction of family and residents and thereby increase the happiness of outlook of the residents.
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Affiliation(s)
- Jesun Lin
- Researcher, Institute of Medicine, Chung Shan Medical University, Taichung CityAssociate Professor, Department of Economics, Tunghai UniversityAssociate Professor, Department of Applied Foreign Languages, Chungshan Medical UniversityProfessor and Chairman, Department of Health Policy and Management, Chung Shan Medical University, Chung Shan Medical University Hospital, TaichungSecretary, Chung Shan Medical University Hospital, Taichung, Taiwan
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Toles M, Anderson RA. State of the science: Relationship-oriented management practices in nursing homes. Nurs Outlook 2011; 59:221-7. [DOI: 10.1016/j.outlook.2011.05.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 04/25/2011] [Accepted: 05/01/2011] [Indexed: 11/27/2022]
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Estabrooks CA, Morgan DG, Squires JE, Boström AM, Slaughter SE, Cummings GG, Norton PG. The care unit in nursing home research: evidence in support of a definition. BMC Med Res Methodol 2011; 11:46. [PMID: 21492456 PMCID: PMC3098823 DOI: 10.1186/1471-2288-11-46] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 04/14/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Defining what constitutes a resident care unit in nursing home research is both a conceptual and practical challenge. The aim of this paper is to provide evidence in support of a definition of care unit in nursing homes by demonstrating: (1) its feasibility for use in data collection, (2) the acceptability of aggregating individual responses to the unit level, and (3) the benefit of including unit level data in explanatory models. METHODS An observational study design was used. Research (project) managers, healthcare aides, care managers, nursing home administrators and directors of care from thirty-six nursing homes in the Canadian prairie provinces of Alberta, Saskatchewan and Manitoba provided data for the study. A definition of care unit was developed and applied in data collection and analyses. A debriefing session was held with research managers to investigate their experiences with using the care unit definition. In addition, survey responses from 1258 healthcare aides in 25 of the 36 nursing homes in the study, that had more than one care unit, were analyzed using a multi-level modeling approach. Trained field workers administered the Alberta Context Tool (ACT), a 58-item self-report survey reflecting 10 organizational context concepts, to healthcare aides using computer assisted personal interviews. To assess the appropriateness of obtaining unit level scores, we assessed aggregation statistics (ICC(1), ICC(2), η², and ω²), and to assess the value of using the definition of unit in explanatory models, we performed multi-level modeling. RESULTS In 10 of the 36 nursing homes, the care unit definition developed was used to align the survey data (for analytic purposes) to specific care units as designated by our definition, from that reported by the facility administrator. The aggregation statistics supported aggregating the healthcare aide responses on the ACT to the realigned unit level. Findings from the multi-level modeling further supported unit level aggregation. A significantly higher percentage of variance was explained in the ACT concepts at the unit level compared to the individual and/or nursing home levels. CONCLUSIONS The statistical results support the use of our definition of care unit in nursing home research in the Canadian prairie provinces. Beyond research convenience however, the results also support the resident unit as an important Clinical Microsystem to which future interventions designed to improve resident quality of care and staff (healthcare aide) worklife should be targeted.
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Affiliation(s)
| | - Debra G Morgan
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Janet E Squires
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Anne-Marie Boström
- Department of Neurobiology, Care Sciences and Science, Division of Nursing, Karolinska Institute, Stockholm, Sweden
| | | | | | - Peter G Norton
- Department of Family Medicine, University of Calgary, Calgary, Canada
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