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Yoon MN, Lu L(L, Ickert C, Estabrooks CA, Hoben M. If we cannot measure it, we cannot improve it: Understanding measurement problems in routine oral/dental assessments in Canadian nursing homes—Part II. Gerodontology 2020; 37:164-176. [DOI: 10.1111/ger.12467] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Minn N. Yoon
- School of Dentistry University of Alberta Edmonton Alberta Canada
| | - Lily (Ling) Lu
- Faculty of Nursing University of Alberta Edmonton Alberta Canada
| | - Carla Ickert
- School of Dentistry University of Alberta Edmonton Alberta Canada
| | | | - Matthias Hoben
- Faculty of Nursing University of Alberta Edmonton Alberta Canada
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Krausch-Hofmann S, De Almeida Mello J, Declerck D, Declercq A, De Lepeleire J, Tran TD, Lesaffre E, Duyck J. The oral health-related section of the interRAI: Evaluation of test content validity by expert rating and assessment of potential reasons for inaccurate assessments based on focus group discussions with caregivers. Gerodontology 2019; 36:382-394. [PMID: 31274218 DOI: 10.1111/ger.12421] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/21/2019] [Accepted: 05/13/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To explore the failure of the oral health-related section of the interRAI (ohr-interRAI), this study investigated test content validity (A.) and reasons for inaccurate assessments (B.). BACKGROUND Poor oral health negatively affects quality of life and is associated with a number of systemic diseases. The interRAI instruments, internationally used for geriatric assessment, should accurately detect oral conditions that require care. Previous research showed that the ohr-interRAI and related precursor versions do not achieve this goal. MATERIALS AND METHODS (A.) A group of 12 experts rated completeness, relevance, clarity of wording and feasibility of the ohr-interRAI. Content validity indices were calculated per item (threshold 0.78). (B.) Focus group discussions with 23 caregivers were organized. A semi-structured question guide made sure that all topics of interest were covered. Qualitative content structuring analysis was applied after transcription. RESULTS (A.) Experts agreed on the relevance of the items on chewing, pain, gingival inflammation and damaged teeth. They regarded none of the items as worded clearly and only prosthesis use and pain were considered to be assessable by untrained caregivers. All experts agreed that the ohr-interRAI was incomplete. (B.) Focus group discussions revealed that in the care environment oral health had low priority. Aspects related to the ohr-interRAI itself and aspects related to the assessment situation impeded the oral health assessment. The approach of the caregivers to complete the ohr-interRAI was inappropriate to accurately detect oral care needs. CONCLUSIONS Findings challenge test content validity of the ohr-interRAI and reveal reasons for inaccurate assessments.
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Affiliation(s)
- Stefanie Krausch-Hofmann
- Department of Oral Health Sciences, KU Leuven Population Studies in Oral Health, Leuven, Belgium
| | | | - Dominique Declerck
- Department of Oral Health Sciences, KU Leuven Population Studies in Oral Health, Leuven, Belgium
| | - Anja Declercq
- Centre for Care Research and Consultancy, KU Leuven LUCAS, Leuven, Belgium
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, KU Leuven Academic Centre for General Practice, Leuven, Belgium
| | - Trung Dung Tran
- Department of Public Health and Primary Care, KU Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Leuven, Belgium
| | - Emmanuel Lesaffre
- Department of Public Health and Primary Care, KU Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Leuven, Belgium
| | - Joke Duyck
- Department of Oral Health Sciences, Biomaterials/BIOMAT, Leuven, Belgium
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Dellefield ME, Corazzini K. Comprehensive Care Plan Development Using Resident Assessment Instrument Framework: Past, Present, and Future Practices. Healthcare (Basel) 2015; 3:1031-53. [PMID: 27417811 PMCID: PMC4934629 DOI: 10.3390/healthcare3041031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/14/2015] [Accepted: 10/14/2015] [Indexed: 11/16/2022] Open
Abstract
Development of the comprehensive care plan (CCP) is a requirement for nursing homes participating in the federal Medicare and Medicaid programs, referred to as skilled nursing facilities. The plan must be developed within the context of the comprehensive interdisciplinary assessment framework-the Resident Assessment Instrument (RAI). Consistent compliance with this requirement has been difficult to achieve. To improve the quality of CCP development within this framework, an increased understanding of complex factors contributing to inconsistent compliance is required. In this commentary, we examine the history of the comprehensive care plan; its development within the RAI framework; linkages between the RAI and registered nurse staffing; empirical evidence of the CCP's efficacy; and the limitations of extant standards of practices in CCP development. Because of the registered nurse's educational preparation, professional practice standards, and licensure obligations, the essential contributions of professional nurses in CCP development are emphasized. Recommendations for evidence-based micro and macro level practice changes with the potential to improve the quality of CCP development and regulatory compliance are presented. Suggestions for future research are given.
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Affiliation(s)
- Mary Ellen Dellefield
- Hahn School of Nursing and Health Sciences, University of San Diego, San Diego, CA 92110, USA.
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
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Wojtusiak J, Levy CR, Williams AE, Alemi F. Predicting Functional Decline and Recovery for Residents in Veterans Affairs Nursing Homes. THE GERONTOLOGIST 2015; 56:42-51. [PMID: 26185151 DOI: 10.1093/geront/gnv065] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/08/2015] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY This article describes methods and accuracy of predicting change in activities of daily living (ADLs) for nursing home patients following hospitalization. DESIGN AND METHODS Electronic Health Record data for 5,595 residents of Veterans Affairs' (VAs') Community Living Centers (CLCs) aged 70 years and older were analyzed within the VA Informatics and Computing Infrastructure. Data included diagnoses from 7,106 inpatient records, 21,318 functional status evaluations, and 69,140 inpatient diagnoses. The Barthel Index extracted from CLC's Minimum Data Set was used to assess ADLs loss and recovery. Patients' diagnoses on hospital admission, ADL status prior to hospitalization, age, and gender were used alone or in combination to predict ADL loss/gain following hospitalization. Area under the Receiver-Operator Curve (AUC) was used to report accuracy of predictions in short (14 days) and long-term (15-365 days) follow-up post-hospitalization. RESULTS Admissions fell into 7 distinct patterns of recovery and loss: early recovery 19%, delayed recovery 9%, delayed recovery after temporary decline 9%, early decline 29%, delayed decline 10%, delayed decline after temporary recovery 6%, and no change 18%. Models accurately predicted ADL's 14-day post-hospitalization (AUC for bathing 0.917, bladder 0.842, bowels 0.875, dressing 0.871, eating 0.867, grooming 0.902, toileting 0.882, transfer 0.852, and walking deficits was 0.882). Accuracy declined but remained relatively high when predicting 14-365 days post-hospitalization (AUC ranging from 0.798 to 0.875). IMPLICATIONS Predictive modeling may allow development of more personalized predictions of functional loss and recovery after hospitalization among nursing home patients.
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Affiliation(s)
- Janusz Wojtusiak
- Department of Health Administration and Policy, George Mason University, Fairfax, Virginia
| | - Cari R Levy
- Department of Internal Medicine, Palliative Care, Veterans Affairs Medical Center Eastern Colorado Health Care System, Denver
| | - Allison E Williams
- Department of Research, Bay Pines Veterans Affairs Healthcare System, Bay Pines, Florida.
| | - Farrokh Alemi
- Department of Health Administration and Policy, George Mason University, Fairfax, Virginia. Office of Chief of Staff, District of Columbia Veterans Affairs Medical Center, Washington, DC
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Wu XV, Heng MA, Wang W. Nursing students' experiences with the use of authentic assessment rubric and case approach in the clinical laboratories. NURSE EDUCATION TODAY 2015; 35:549-555. [PMID: 25577674 DOI: 10.1016/j.nedt.2014.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 12/04/2014] [Accepted: 12/15/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND One current challenge for nurse educators is to examine effective nursing assessment tools which integrate nursing knowledge into practice. Authentic assessment allows nursing students to apply knowledge to real-life experiences. Contextualized cases have engaged students for preparation of diverse clinical situations and develop critical thinking skills. AIM This study aimed to explore nursing students' experiences and learning outcomes with the use of an authentic assessment rubric and a case approach. METHODS An exploratory qualitative approach using focus-group discussions and an open-ended survey was adopted. Sixteen nursing students participated in three focus-group discussions and 39 nursing students completed an open-ended survey. RESULTS Nursing students noted that an authentic assessment rubric with a case approach provided clarity for their learning goals; built confidence; developed knowledge, skill competencies and critical thinking skills; increased awareness of caring attributes and communication skills; and enriched and extended learning through self-, peer- and teacher-assessments. CONCLUSIONS These findings provide rich insights for nurse educators and curriculum developers in the use of an authentic assessment rubric and a case approach in nursing education.
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Affiliation(s)
- Xi Vivien Wu
- Alice Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Mary Anne Heng
- National Institute of Education, Nanyang University of Technology, Singapore
| | - Wenru Wang
- Alice Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Stolle C, Wolter A, Roth G, Rothgang H. Improving health status and reduction of institutionalization in long-term care--Effects of the Resident Assessment Instrument-Home Care by degree of implementation. Int J Nurs Pract 2014; 21:612-21. [PMID: 24773523 DOI: 10.1111/ijn.12332] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A cluster randomized controlled trial showed that the Resident Assessment Instrument (RAI) could not improve or stabilize the health status of people in need of long-term care or reduce the rate of institutionalization in Germany among clients of home care agencies. The aim of this article is to investigate whether the effect of RAI depends on the degree of implementation. A factor analysis was used to distinguish between those agencies that implemented RAI intensively and those that did not. The clients of home care agencies working intensively with RAI were significantly less hospitalized (P = 0.0284) and fared slightly better according to activities of daily living (ADL, instrumental ADL (IADL)), cognitive skills (Mini-Mental Status Test (MMST)) and quality of life (EuroQol (EQ-5D)) compared with the control group. In contrast, those not working intensively with RAI had worse outcomes (IADL, MMST, EQ-5D) than the control group (not significant). It is important to guarantee a successful implementation of RAI.
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Affiliation(s)
- Claudia Stolle
- Zentrum für Sozialpolitik (ZeS), Universität Bremen, Bremen, Germany
| | | | - Günter Roth
- Hochschule für angewandte Wissenschaften München, München, Germany
| | - Heinz Rothgang
- Zentrum für Sozialpolitik (ZeS), Universität Bremen, Bremen, Germany
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Quality assurance and performance improvement in nursing homes: using evidence-based protocols to observe nursing care processes in real time. J Nurs Care Qual 2013; 28:43-51. [PMID: 22902936 DOI: 10.1097/ncq.0b013e31826b090b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Quality Assurance and Performance Improvement Initiative, a component of the Affordable Care Act (2010), is a new approach to quality improvement for US nursing homes. The article describes components of the Quality Assurance and Performance Improvement Initiative, the unique contributions of registered nurses to its implementation, and data collection strategies using direct observation and evidence-based measures and protocols in a Quality Assurance and Performance Improvement program.
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Roth G, Wolter A, Stolle C, Rothgang H. The long and bumpy road to outcome-oriented management of long-term care in Germany: implementation of the Resident Assessment Instrument in home-care services. Int J Health Plann Manage 2013; 29:316-29. [PMID: 23671001 DOI: 10.1002/hpm.2186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Although the quality of long-term care has improved, many problems still remain, and better processes seem to be necessary. Hence, outcome-oriented management is of particular importance. The Resident Assessment Instrument (RAI) is a tool that has been used successfully in many countries to improve quality of care. However, there are problems of implementation and it lacks information on the conditions of successful or failing information of the RAI. The aim of this article is to find out to what extent technical/qualification requirements help to introduce or lead to failure of the implementation of an assessment instrument like RAI. METHODS Therefore, a cluster randomized controlled trial showed services using RAI intensively tend to have better outcomes after 12 months. But the effects depend on the success of the implementation. Using a factor analysis, an index was built to divide the care providers into "optimal" and "suboptimal" RAI users. RESULTS Some factors that seem to lead to a rather successful implementation could be detected: A higher proportion of qualified staff, a lower perceived quantitative workload, a small size of care providers, the type of ownership (for-profit) and a late entry in study [Correction made here after initial online publication.]. CONCLUSION The success or failure of the implementation of an outcome-oriented control instrument is determined by professional, organizational restrictions. The results show that a better implementation leads to better outcomes for clients.
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Affiliation(s)
- Günter Roth
- Munich University of Applied Sciences, Department of Applied Social Sciences, Germany
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The Relationship Between Nursing Staff Levels, Skill Mix, and Deficiencies in Maryland Nursing Homes. Health Care Manag (Frederick) 2013; 32:123-8. [DOI: 10.1097/hcm.0b013e31828ef5f9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Effects of the Resident Assessment Instrument in home care settings: results of a cluster randomized controlled trial. Z Gerontol Geriatr 2012; 45:315-22. [PMID: 21769512 DOI: 10.1007/s00391-011-0221-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Deficits in quality, a lack of professional process management and, most importantly, neglect of outcome quality are criticized in long-term care. A cluster randomized, controlled trial was conducted to assess whether the Resident Assessment Instrument (RAI) can help to improve or stabilize functional abilities (ADL, IADL) and cognitive skills (MMST), improve quality of life (EQ-5D), and reduce institutionalization, thereby, increasing outcome quality. A total of 69 home care services throughout Germany were included and randomized. The treatment group (n = 36) received training in RAI and was supported by the research team during the study (13 months). Comparison of mean differences between the treatment and control groups (n = 33) showed no significant effect. Although the multilevel regression results show that clients in the treatment group fared better in terms of ADLs and IADLs (smaller decline) and were less likely to move to nursing homes and be hospitalized, none of these effects is significant. The lack of significance might result from the small number of clients included in the study. Moreover, RAI was not fully implemented and even partial implementation required more time than expected.
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Dellefield ME, Harrington C, Kelly A. Observing How RNs Use Clinical Time in a Nursing Home: A Pilot Study. Geriatr Nurs 2012; 33:256-63. [DOI: 10.1016/j.gerinurse.2012.01.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 01/03/2012] [Accepted: 01/09/2012] [Indexed: 11/29/2022]
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The Improving Efficiency Frontier of Inpatient Rehabilitation Hospitals. Health Care Manag (Frederick) 2011; 30:313-21. [DOI: 10.1097/hcm.0b013e318235100b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dellefield ME. The work of the RN Minimum Data Set coordinator in its organizational context. Res Gerontol Nurs 2010; 1:42-51. [PMID: 20078017 DOI: 10.3928/19404921-20080101-04] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Resident Assessment Instrument/Minimum Data Set (RAI/MDS) is the foundational clinical framework for nursing home care, functioning as both a clinical assessment instrument and an assessment process. An RN is mandated by statute to complete or coordinate the work associated with this framework. Using both focus groups and questionnaires, 24 RN MDS coordinators attending a national conference for MDS coordinators described their work in its organizational context. Shortell et al.'s continuous quality framework of structural, technical, cultural, and strategic organizational dimensions was used to categorize descriptive themes. Clinical implications of the study findings are summarized.
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Affiliation(s)
- Mary Ellen Dellefield
- Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
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Thein HH, Gomes T, Krahn MD, Wodchis WP. Health status utilities and the impact of pressure ulcers in long-term care residents in Ontario. Qual Life Res 2009; 19:81-9. [PMID: 20033300 PMCID: PMC2804787 DOI: 10.1007/s11136-009-9563-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2009] [Indexed: 11/21/2022]
Abstract
Purpose To estimate health status utilities in long-term care (LTC) residents in Ontario, both with and without pressure ulcers (PUs), and to determine the impact of PU on health-related quality of life (HRQOL). Methods A retrospective population-based study was carried out using Minimum Data Set (MDS) health assessment data among all residents in 89 LTC homes in Ontario who had a full MDS assessment between May 2004 and November 2007. The Minimum Data Set-Health Status Index (MDS-HSI) was used to measure HRQOL. A stepwise regression was used to determine the impact of PU on MDS-HSI scores. Results A total of 1,498 (9%) of 16,531 LTC residents had at least one stage II PU or higher. The mean ± SD MDS-HSI scores of LTC residents without PU and those with PU were 0.36 ± 0.17 and 0.26 ± 0.13, respectively (p < 0.001). Factors associated with lower MDS-HSI scores included: older age; being female; having a PU; recent hip fracture; multiple comorbid conditions; bedfast; incontinence; Changes in Health, End-stage disease and Symptoms and Signs; clinically important depression; treated with a turning/repositioning program; taking antipsychotic medications; and use of restraints. Conclusions LTC residents with PU had slightly though statistically significantly lower HRQOL than those without PU. Comorbidity contributed substantially to the low HRQOL in these populations. Community-weighted MDS-HSI utilities for LTC residents are useful for cost-effectiveness analyses and help guide health policy development.
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Affiliation(s)
- Hla-Hla Thein
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada.
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Kontos PC, Miller KL, Mitchell GJ. Neglecting the importance of the decision making and care regimes of personal support workers: a critique of standardization of care planning through the RAI/MDS. THE GERONTOLOGIST 2009; 50:352-62. [PMID: 20026525 PMCID: PMC2867498 DOI: 10.1093/geront/gnp165] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE The Resident Assessment Instrument-Minimum Data Set (RAI/MDS) is an interdisciplinary standardized process that informs care plan development in nursing homes. This standardized process has failed to consistently result in individualized care planning, which may suggest problems with content and planning integrity. We examined the decision making and care practices of personal support workers (PSWs) in relation to the RAI/MDS standardized process. DESIGN AND METHODS This qualitative study utilized focus groups and semi-structured interviews with PSWs (n = 26) and supervisors (n = 9) in two nursing homes in central Canada. RESULTS PSWs evidenced unique occupational contributions to assessment via proximal familiarity and biographical information as well as to individualizing care by empathetically linking their own bodily experiences and forging bonds of fictive kinship with residents. These contributions were neither captured by RAI/MDS categories nor relayed to the interdisciplinary team. Causal factors for PSW exclusion included computerized records, low status, and poor interprofessional collaboration. Intraprofessional collaboration by PSWs aimed to compensate for exclusion and to individualize care. IMPLICATIONS Exclusive institutional reliance on the RAI/MDS undermines quality care because it fails to capture residents' preferences and excludes input by PSWs. Recommendations include incorporating PSW knowledge in care planning and documentation and examining PSWs' nascent occupational identity and their role as interprofessional brokers in long-term care.
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Affiliation(s)
- Pia C Kontos
- Toronto Rehabilitation Institute, 11035-550 University Avenue, Toronto, Ontario, Canada M5G 2A2.
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