Diffusion of innovation. A model for implementation of prompted voiding in long-term care settings

"Dignity": A central construct in nursing home staff understandings of quality continence care

AIMS AND OBJECTIVES

To explore nursing home staff members' beliefs and expectations about what constitutes "quality continence care" for people living in nursing homes.

BACKGROUND

Most nursing home residents require assistance to maintain continence or manage incontinence. Best practice guidelines promote active investigation of incontinence, treatment of underlying potentially reversible causes, and initial conservative interventions to prevent, minimise and/or treat incontinence. Despite research showing the positive benefits of implementing active interventions, translating the findings of research into practice in nursing homes has been modest. Understanding the perspectives of individuals who provide continence care may help bridge the gap between evidence and practice.

DESIGN

A qualitative exploratory descriptive design.

METHODS

Qualitative interviews were conducted with 19 nursing home staff: eight registered nurses, four enrolled nurses and seven personal care workers working in a nursing home in Australia between 2014-2015. Data were analysed inductively to identify themes and subthemes that described and explained staff beliefs about quality continence care in nursing homes.

FINDINGS

Participants' understanding and expectations about quality continence care were linked to beliefs about incontinence being an intractable and undignified condition in nursing homes. The key theme to emerge was "protecting residents' dignity" which was supported by the following six subthemes: (i) using pads, ii) providing privacy, (iii) knowing how to "manage" incontinence, (iv) providing timely continence care, (v) considering residents' continence care preferences and (vi) communicating sensitively.

CONCLUSION

The findings provide new insight into the basis for continence care practices in nursing homes. Education about continence care should challenge beliefs that limit continence care practice to cleaning, containing and concealing incontinence. There is a need for a multidimensional framework that is informed by social, psychological and biomedical research about incontinence, research about the fundamental elements of care, care-dependent individuals' expectations about care, and values about dignity and care.

RELEVANCE TO CLINICAL PRACTICE

The in-depth exploration led to an understanding of the basis for continence care practices that centre on cleaning, containing and concealing residents' incontinence in some nursing homes. There is a need to review the quality of education for the aged care workforce about incontinence to ensure it equips them with a broad understanding of the fundamentals of care and how to enact dignity in continence care through a resident-centred approach.

Evidence based practice in long term care settings

PURPOSE

The purpose of this manuscript is to discuss the need for use of evidence based practice (EBP) in LTC, the current use of evidence in long term care facilities and what we know about adoption of the use of EBP in LTC.

METHODS

Literature review and reporting of findings from the M-TRAIN study that was a quasi-experimental design to test the effectiveness of an intervention to increase the use of EBPs for urinary incontinence and pain in 48 LTC facilities.

RESULTS

Barriers to adopting EBPs include lack of available time, lack of access to current research literature, limited critical appraisal skills, excessive literature to review, non-receptive organizational culture, limited resources, and limited decision-making authority of staff to implement change. Strategies to promote adoption of EBP include the commitment of management; the culture of the home; leadership; staff knowledge, time, and reward; and facility size, complexity, the extent that members are involved outside the facility, NH chain membership, and high level of private pay residents. Findings from the M-TRAIN add, stability of nurse leader and congruency between the leaders perception of their leadership and the staff's perception of the leadership.

CONCLUSION

There is clear evidence of the need and the benefits to residents of LTC and to the health care system yet adoption of EBP continues to be slow and sporadic. There is also evidence for the process of establishing best evidence and many resources to find the available EBPs. The urgent need now is finding ways to best get the EBPs implemented in LTC. There is growing evidence about best methods to do this but continued research is needed. Clearly, residents in LTC deserve the best care possible and EBPs represent an important vehicle by which to do this.

Nurses' perception and barriers to use of information communication technology in a teaching hospital in Nigeria

The impact of information technology on nursing has been a subject of discourse for the latter half of the 20th century and the early part of the 21st. Despite its obvious benefits, adapting information technology to healthcare has been relatively difficult, and rates of use have been limited especially in many developing countries. This quantitative study has shown a generally low usage of information technology among nurses in the study setting. Many of the nurses adjudged themselves as novice in information technology, with 37.8% stating that they had never had formal training in information technology and many rating themselves as possessing little or no skill in the use of spreadsheet, databases, and so on. Many (55.6%) stated that they do not have access to information technology despite the fairly widespread satisfactory perception established among them. Results further showed that unreliable network connections, high work demand, inadequate number of computers, poor access to computers consequent on wrong locations, and poor system design with associated failure to fit work demands are some of the major barriers to the use of information technology in the study setting. These factors therefore need to be taken into consideration in any intervention that seeks to improve the nurses' use of information technology in clinical setting.

The Connected Learning Model for disseminating evidence-based care practices in clinical settings

Clinical practice guidelines have been developed to improve patient care and outcomes. Guideline implementation is often stymied by the complexity of patients' conditions, complex care environments, and limited advanced clinical training of nursing staff. To translate key elements of heart failure guidelines into practice in a nursing home, the Connected Learning Model was developed based on the diffusion of innovations framework. An advanced practice nurse in geriatrics fostered greater interaction and collaboration among key administrative, medical, and nursing staff to promote awareness of heart failure guidelines and to translate key practices from those guidelines into the nursing home setting. Direct care staff skills for early recognition and reporting of signs and symptoms of acute heart failure were enhanced through a learner-centered educational program which included classroom and unit-based instruction and bedside clinical teaching. The Connected Learning Model is a promising method to mobilize advanced nursing expertise to bridge research/practice gaps through implementation of clinical practice guidelines that are systematically adapted to accommodate diverse health care contexts.

Using principles of diffusion of innovation to improve nursing home care

Principles of diffusion of innovation were used to change care provided to people with dementia in 9 nursing homes. Use of these principles was associated with increased assessment in response to behavior change, increased administration of analgesics, and a significant decrease in resident behavioral symptoms. Results of this study support the emerging consensus that diffusion of innovation is an effective model for making changes in performance of healthcare organizations.

Knowledge and attitudes of nursing home staff and surveyors about the revised federal guidance for incontinence care

PURPOSE

We assessed nursing home staff and state nursing home surveyors regarding their knowledge and attitudes about urinary incontinence, its management, and the revised federal Tag F315 guidance for urinary incontinence.

DESIGN AND METHODS

We conducted a questionnaire survey of a convenience sample of nursing home staff and state nursing home surveyors from a midwestern state attending two statewide workshops on the revised guidance.

RESULTS

Of 558 attendees, 500 (85%) responded, including 39% of the state's directors of nursing and 57% of state nursing home surveyors. There were striking deficiencies in knowledge regarding urinary incontinence and catheter care, with significant discrepancies by type of respondent, particularly between state surveyors and nursing home staff. Staff cited documentation and staffing levels as the most frequent concerns about implementation. Open-ended responses reflected the divergence of concerns and antagonism among the stakeholders, and staff nurses' feeling that F315 violated residents' rights.

IMPLICATIONS

The revised Tag F315 guidance will be unlikely to improve the quality of urinary incontinence care in nursing homes because of significant knowledge and attitudinal discrepancies between nursing home staff and state surveyors, facility staff's focus on documentation and staffing, and reliance on implementation strategies known to be ineffective. Federal, state, and other urinary incontinence guideline efforts should focus on managerial structures and methods to improve quality nursing home care. Research is needed to address how nursing home residents and families define and value "quality" urinary incontinence management and to incorporate these in quality-improvement strategies and measures.

Developing a theory-based taxonomy of methods for implementing change in practice

AIM

In this paper we present a theory-based taxonomy of the methods used to implement change in practice.

BACKGROUND

Implementation research is characterized by inconsistent terminology for the methods employed and inattention to differences in the relevance of methods across different disciplines. Studies of the effectiveness of implementation have yielded mixed results. Positive effects shown have been small. The limited success of many efforts to implement change in practice may be due, in part, to the absence of a framework to guide the use of implementation methods.

METHOD

A provisional taxonomy of implementation methods, derived from theory and existing taxonomies, was used to content analyse a convenience sample of 43 reports of empirical studies of the implementation of one or more research-based practice changes involving nurses that had been published between 1995 and 2005. This taxonomy was revised throughout the course of analysis to capture more completely the information in each report.

FINDINGS

Following the analysis, nine of the 11 methods in the provisional taxonomy were retained, two were removed and five new methods were identified. The final taxonomy includes 14 implementation methods organized into five categories: (a) increasing coordination; (b) raising awareness; (c) persuasion via interpersonal channels; (d) persuasion via reinforcing belief that behaviour will lead to desirable results and (e) increasing behavioural control.

CONCLUSIONS

The taxonomy presented here differs from prior taxonomies by focusing on nursing and by providing a clear and mutually exclusive guide to implementation methods. By deriving the initial coding strategy from theory, the taxonomy links the methods to theoretical constructs that may inform the selection of methods across different practice changes and settings.

Factors affecting the use of nursing information systems in Taiwan

AIM

This paper reports a study to test a proposed model of factors (demographic variables, computer experience and perceived technology characteristics) influencing the efficient use of a computerized nursing care planning system by hospital clinical nurses.

BACKGROUND

Although nursing information systems have been used in health care institutions, little research has explored the efficiency of computer use in nurses' daily practice.

METHOD

A secondary data analysis was applied to focus on clinical nurses' daily computer use. The original data were collected from a medical centre in Taiwan to establish the reliability and validity of a scale to evaluate computerized nursing care plan systems.

RESULTS

Younger nurses with more education, less computer knowledge and less usage pressure, and who perceived that they had less usage benefit, more education training and usability regarding system use, spent less time on the computerized nursing care plan.

CONCLUSION

The results can be used for further organization of education programmes and as a reference for training strategies. Further examination and analysis of item content are suggested.

Quality improvement and incontinence in long-term care

The quality improvement framework provides a practical way for nursing homes to prevent and reduce urinary incontinence (UI)for residents. It provides a means for facilities to identify organizational factors that may be hindering appropriate continence care from being provided to residents. It enables nursing homes to integrate evidence-based UI practices and monitor the consistent application of those practices by staff. The regular collection and analysis of data related to UI is essential for identifying problems,seeking accurate solutions, providing staff with feedback regarding their performance, and evaluating the overall quality of continence care provided to residents.

Comprehensive management of urinary incontinence through quality improvement efforts

This article provides a comprehensive examination of eight factors to analyze the potential and contributing causes of urinary incontinence (UI) in long-term care facilities. These factors can guide quality improvement committees to reduce the prevalence of UI. The eight factors--evidence-based practice, assessment, environment, education, staffing, communication, involvement, and evaluation/feedback--were identified through an analysis of 70 quality improvement plans developed by Minnesota nursing facilities and substantiated by the research literature.