1
|
Kiljunen O, Savela RM, Välimäki T, Kankkunen P. Managers' perceptions of the factors affecting resident and patient safety work in residential settings and nursing homes: A qualitative systematic review. Res Nurs Health 2024; 47:397-408. [PMID: 38522016 DOI: 10.1002/nur.22382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/23/2024] [Accepted: 03/15/2024] [Indexed: 03/25/2024]
Abstract
Identifying ways to ensure resident safety is increasingly becoming a priority in residential settings and nursing homes. The aim of this qualitative systematic review was to identify, describe, and assess research evidence on managers' perceptions regarding the barriers and facilitators of daily resident and patient safety work in residential settings and nursing homes. A qualitative systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist. Published studies were sought through academic databases: Academic Search Premier, CINAHL, PubMed (MEDLINE), Scopus, SocINDEX, and Web of Science Core Collection in April 2023. Finally, 12 studies were included. The results of the included studies were synthesized using thematic synthesis after data extraction. According to the results, (1) competent staff and material resources; (2) management and culture; (3) communication, networks, optimal use of expertise; and (4) effective use of guidelines, rules, and regulations play a significant role in the success of resident and patient safety work. The findings revealed that promoting resident safety should not be seen solely as the responsibility of individual residential or nursing home personnel, as it requires multiprofessional cooperation and access to wider networks. Staff and managers must be receptive to learning, changing, and improving safety. Moreover, to ensure resident safety, it is essential to ensure that the organizations support safety work in residential and nursing home units.
Collapse
Affiliation(s)
- Outi Kiljunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Roosa-Maria Savela
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Tarja Välimäki
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Päivi Kankkunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
2
|
Kim D, Choi YR, Lee YN, Chang SO. Nurses' Shared Subjectivity on Person-Centered Care for Behavioral and Psychological Symptoms of Dementia in Nursing Homes. J Nurs Res 2024; 32:e330. [PMID: 38727209 DOI: 10.1097/jnr.0000000000000611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Person-centered care (PCC), an approach to healthcare that focuses on the individual needs, preferences, and values of patients, is particularly important in the context of caring for residents of nursing homes (NHs) with the behavioral and psychological symptoms of dementia (BPSD). However, implementing PCC in NHs varies widely due to individual staff, NH environment, and country factors, leading to heterogeneity in person-centered approaches. PURPOSE This study was designed to explore and gain insight into the shared subjective perspectives of nurses on providing PCC to manage BPSD in NHs in order to elicit a deeper understanding of how nurses interpret and approach the provision of PCC. METHODS Q methodology was applied to explore the subjective perspectives of nurses. Twenty-nine NH nurses with more than 3 years of experience in managing BPSD completed a Q-sorting task, categorizing 43 Q-samples into a normal distribution shape. Postsorting interviews were conducted after the participants had completed this task. The collected data were analyzed using centroid factor analysis and varimax rotation run within the PQMethod 2.35 program. Interpretation of the resulting factors was based on factor arrays, field notes, and interview data. RESULTS Four factors from the shared subjective perspectives of nurses related to PCC were identified, including (a) sharing information focused on details to update care strategies, (b) monitoring until the true needs of residents are identified, (c) awareness of interactive cues in relationships, and (d) connecting an individual's life pattern to their current care. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The findings highlight that a one-size-fits-all approach may not be suitable for all nurses and interventions, indicating that nurses should consider the applicable subjective frames to ensure the effectiveness of planned interventions. A need for PCC education that specifically addresses BPSD management is suggested, with the findings implying that a strong organizational climate with respect to PCC in managing BPSD should promote higher job satisfaction and commitment and reduce turnover rates among nurses in NHs. Facilitating the development of PCC interventions appropriate for BPSD management that encompass the various categories and ranges of NH settings and nursing phenomena is thus recommended.
Collapse
Affiliation(s)
- Dayeong Kim
- MSN, RN, Doctoral Student, College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Republic of Korea
| | - Young-Rim Choi
- PhD, RN, Research Professor, College of Nursing, Korea University, Republic of Korea
| | - Ye-Na Lee
- PhD, RN, Assistant Professor, Department of Nursing, The University of Suwon, Republic of Korea
| | - Sung Ok Chang
- PhD, RN, Professor, College of Nursing and L-HOPE Program for Community-Based Total Learning Health Systems, Korea University, Republic of Korea
| |
Collapse
|
3
|
Behrens LL, Madrigal C, Dellefield ME. Assessment of Nursing Staff Learning Needs Around Person-Centered Risk Management in Nursing Homes. J Gerontol Nurs 2023; 49:7-12. [PMID: 36719662 DOI: 10.3928/00989134-20230106-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The purpose of the current study was to describe nursing home (NH) staff's perceived learning and practice competency needs to facilitate effective delivery of person-centered care (PCC) when older adult residents' care preferences involve perceived risks. This needs assessment included a survey of NH staff and leaders (N = 87) and two focus groups (FGs) (N = 14). Results indicated staff were most confident handling preferences related to medication refusal (mean item rating = 4.1) and least confident in preferences related to smoking (mean item rating = 2.4). Staff were challenged in denying residents' preferences (mean item rating = 3.6) and worried about risk outcomes for residents or themselves (71.6%), reporting lack of policy and procedures to support them (48.1%). Survey results were enriched by FG themes: Establishing Person-Centered Values, Navigating Risk, and Operational Characteristics. Together, this information informed the development of a practice protocol to improve nursing competence in situations involving negotiation of resident and/or NH risks in care delivery. [Journal of Gerontological Nursing, 49(2), 7-12.].
Collapse
|
4
|
Behrens LL, Boltz M, Sciegaj M, Kolanowski A, Jones JR, Paudel A, Van Haitsma K. Nursing Staff Perceptions of Outcomes Related to Honoring Residents' "Risky" Preferences. Res Gerontol Nurs 2022; 15:271-281. [PMID: 36214738 PMCID: PMC10189806 DOI: 10.3928/19404921-20220930-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Nursing homes (NHs) are challenged to consistently deliver person-centered care (PCC), or care based on residents' values and preferences. NH staff associate certain resident preferences with risk. However, there are limited evidence-based person-centered risk management strategies to assist NH staff with risky resident preferences. The purpose of the current study was to explore NH staff perceptions of health and safety outcomes associated with honoring NH residents' risky preferences to inform intervention development. This descriptive, qualitative study used sequential focus groups and content analysis, revealing that nursing staff perceive negative and positive outcomes for staff and residents when seeking to honor residents' risky preferences. This finding is supported by three themes: Potential Harms to Staff, Potential Harms to Residents, and Positive Shared Outcomes. These results contribute a set of nurse-driven quality of life and quality of care outcomes for NH staff and residents associated with PCC delivery in NHs. [Research in Gerontological Nursing, 15(6), 271-281.].
Collapse
|
5
|
Perceptions and experiences of person-centered care among nurses and nurse aides in long term residential care facilities: A systematic review of qualitative studies. Geriatr Nurs 2021; 42:816-824. [PMID: 34090225 DOI: 10.1016/j.gerinurse.2021.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study is to report the findings of meta-synthesis of the experiences and perceptions of person-centered care among nurses and nurse aides in long term care facilities to help managers and policy makers in providing and improving health services. METHODS This is a meta-synthesis of qualitative studies guided by seven steps process of meta-ethnography developed by Noblit and Hare. Systematic literature searching was conducted in CINAHL, MEDLINE, Web of Science, PubMed, PsycINFO, Scopus, Cochrane library and ProQuest dissertations databases. We assessed quality of the studies using Critical Appraisal Skills Program tool. RESULTS Eleven studies and one dissertation were identified as relevant for the review. The analysis of this systematic review was resulted in three categories: Recognizing resident's emotional needs and preferences under the task-based workload; holistic understanding to build relationship and participation; teamwork, being recognized and ongoing training to overcome the challenges. CONCLUSION The concept of PCC in direct care level is perceived well with majority of the study participants but the reality between perceived and practicing PCC is different which indicates mostly lack of organizational rearrangements and support.
Collapse
|
6
|
Stutzbach JA, Gustavson AM, Derlein DL, Forster JE, Boxer RS, Stevens-Lapsley JE. Older adults in skilled nursing facilities demonstrate low physical activity during and after discharge. Disabil Rehabil 2021; 44:3909-3914. [PMID: 33836134 DOI: 10.1080/09638288.2021.1892838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE This study sought to quantify physical activity and sedentary time among older adults during a skilled nursing facility (SNF) stay and after the transition home, a critical period when patients are at high risk for adverse events. MATERIALS AND METHODS We performed an observational cohort study of physical activity and sedentary behavior during the last 3-5 days before discharge from SNF and the initial 3-5 days at home using accelerometers. Participants answered questions about perceived physical activity in the SNF and at home. RESULTS A convenience sample of thirty-one residents from two SNFs were included. Participants spent a median 12.2% (interquartile range [IQR], 17.3%) of time upright in the SNF and 16.8% (IQR, 15.2%) of their time upright at home (p = 0.002) and took a median of 849 steps (IQR, 1772) in the SNF and 922 steps (IQR, 1906) at home (p = 0.57), per day. Participants averaged fewer sitting bouts at home (p = 0.03), but there was no difference in sit-to-stand transitions (p = 0.32) or activity scores (p = 0.67). Subjective perceptions of physical activity appeared to be higher than objective measurements. CONCLUSION In an exploratory study, SNF residents demonstrated profoundly low levels of physical activity both during and after their SNF stay. Future studies using larger sample sizes should examine physical activity during the SNF to home transition as well as barriers and facilitators to physical activity in post-acute care environments.IMPLICATIONS FOR REHABILITATIONSNF residents in this study demonstrated low levels of physical activity and high rates of sedentary behavior that persisted after discharge home.Interventions to improve physical activity levels in the SNF are sorely needed, and those interventions should include a plan for progressing physical activity after the transition home.Objective measurement of physical activity using activity monitors may prove clinically useful for older adults following hospitalization in the SNF and home settings.
Collapse
Affiliation(s)
- Julie A Stutzbach
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
| | - Allison M Gustavson
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
| | - Danielle L Derlein
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
| | - Jeri E Forster
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
| | - Rebecca S Boxer
- Kaiser Permanente Colorado Institute for Health Research, Aurora, CO, USA
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA.,Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC), Aurora, CO, USA
| |
Collapse
|
7
|
Rand S, Smith N, Jones K, Dargan A, Hogan H. Measuring safety in older adult care homes: a scoping review of the international literature. BMJ Open 2021; 11:e043206. [PMID: 33707269 PMCID: PMC7957135 DOI: 10.1136/bmjopen-2020-043206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Safety is a key concern in older adult care homes. However, it is a less developed concept in older adult care homes than in healthcare settings. As part of study of the collection and application of safety data in the care home sector in England, a scoping review of the international literature was conducted. OBJECTIVES The aim of the review was to identify measures that could be used as indicators of safety for quality monitoring and improvement in older adult residential or nursing care homes. SOURCES OF EVIDENCE Systematic searches for journal articles published in English language from 1 January 1970, without restriction to the study location or country, were conducted in Web of Science, Scopus and PubMed on 28 July 2019. ELIGIBILITY CRITERIA Inclusion criteria were: peer-reviewed journal articles; qualitative or quantitative studies of older adult nursing and/or residential care homes; and related to any aspect of safety in care homes, including the safety of healthcare provision in the care home. A total of 45 articles were included after review of the title/abstract or full text against the inclusion criteria. CHARTING METHODS Key information was extracted and charted. These findings were then mapped to the Safety Measurement and Monitoring Framework in healthcare (SMMF), adapted by the research team to reflect the care home context, to determine the coverage of different aspects of safety, as well as potential gaps. RESULTS AND CONCLUSIONS Systematic searches for journal articles published in English language from 1 January 1970, without restriction to the study location or country, were conducted in Web of Science, Scopus and PubMed on 28 July 2019. Inclusion criteria were: peer-reviewed journal articles; qualitative or quantitative studies of older adult nursing and/or residential care homes; and related to any aspect of safety in care homes, including the safety of healthcare provision in the care home.A total of 45 articles were included after review of the title/abstract or full text against the inclusion criteria. Key information was extracted and charted. These findings were then mapped to the Safety Measurement and Monitoring Framework in healthcare (SMMF), adapted by the research team to reflect the care home context, to determine the coverage of different aspects of safety, as well as potential gaps.The findings indicate that there are a range of available safety measures used for quality monitoring and improvement in older adult care homes. These cover all five domains of safety in the SMMF. However, there are potential gaps. These include user experience, psychological harm related to the care home environment, abusive or neglectful care practice and the processes for integrated learning. Some of these gaps may relate to challenges and feasibility of measurement in the care home context.
Collapse
Affiliation(s)
- Stacey Rand
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, UK
| | - Nick Smith
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, UK
| | - Karen Jones
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, UK
| | - Alan Dargan
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent, UK
| | - Helen Hogan
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
8
|
Behrens LL, Boltz M, Kolanowski A, Sciegaj M, Madrigal C, Abbott K, Van Haitsma K. Pervasive Risk Avoidance: Nursing Staff Perceptions of Risk in Person-Centered Care Delivery. THE GERONTOLOGIST 2020; 60:1424-1435. [PMID: 32756959 PMCID: PMC7759749 DOI: 10.1093/geront/gnaa099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Nursing home (NH) staff perceptions of risks to residents' health and safety are a major barrier to honoring resident preferences, the cornerstone of person-centered care (PCC) delivery. This study explored direct-care nursing staff perceptions of risk (possibilities for harm or loss) associated with honoring residents' preferences for everyday living and care activities. RESEARCH DESIGN AND METHODS Qualitative, descriptive design using sequential focus group (FG) methodology. RESULTS Participants (N = 27) were mostly female (85%), had more than 3 years of experience (74%), and worked in NHs recently experiencing 6-12 health citations. Content analysis of 12 sequential FGs indicated nursing staff perceptions of risks may impede delivery of person-centered care. This is supported by the overarching theme: pervasive risk avoidance; and subthemes of: staff values, supports for risk-taking, and challenges to honoring preferences. DISCUSSION AND IMPLICATIONS Development of a multidimensional framework with specific risk engagement measures that account for the unique risk perspectives of nursing staff will contribute significantly to the clinical management of older adult preferences and research on the effectiveness of preference-based PCC delivery in the NH setting.
Collapse
Affiliation(s)
- Liza L Behrens
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia
| | - Marie Boltz
- College of Nursing, Pennsylvania State University, State College
| | - Ann Kolanowski
- College of Nursing, Pennsylvania State University, State College
| | - Mark Sciegaj
- College of Health and Human Development, Pennsylvania State University, State College
| | - Caroline Madrigal
- Center for Innovations in Long-term Services and Supports, Providence Veterans Affairs Medical Center, Rhode Island
| | - Katherine Abbott
- Department of Sociology and Gerontology, Miami University, Oxford, Ohio
| | | |
Collapse
|
9
|
Ebrahimi Z, Patel H, Wijk H, Ekman I, Olaya-Contreras P. A systematic review on implementation of person-centered care interventions for older people in out-of-hospital settings. Geriatr Nurs 2020; 42:213-224. [PMID: 32863037 DOI: 10.1016/j.gerinurse.2020.08.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/13/2022]
Abstract
THE PURPOSE of this study was to explore the content and essential components of implemented person-centered care in the out-of-hospital context for older people (65+). METHOD A systematic review was conducted, searching for published research in electronic databases: PubMed, CINAHL, Scopus, PsycInfo, Web of Science and Embase between 2017 and 2019. Original studies with both qualitative and quantitative methods were included and assessed according to the quality assessment tools EPHPP and CASP. The review was limited to studies published in English, Swedish, Danish, Norwegian and Spanish. RESULTS In total, 63 original articles were included from 1772 hits. The results of the final synthesis revealed the following four interrelated themes, which are crucial for implementing person-centered care: (1) Knowing and confirming the patient as a whole person; (2) Co-creating a tailored personal health plan; (3) Inter-professional teamwork and collaboration with and for the older person and his/her relatives; and (4) Building a person-centered foundation. CONCLUSION Approaching an interpersonal and inter-professional teamwork and consultation with focus on preventive and health promoting actions is a crucial prerequisite to co-create optimal health care practice with and for older people and their relatives in their unique context.
Collapse
Affiliation(s)
- Zahra Ebrahimi
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Person-Centred Care University of Gothenburg (GPCC), Gothenburg, Sweden.
| | - Harshida Patel
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Chalmers University of Technology, Department of Architecture Sahlgrenska University Hospital Department of Quality Assurance and Patient Safety, Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Person-Centred Care University of Gothenburg (GPCC), Gothenburg, Sweden
| | - Patricia Olaya-Contreras
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
10
|
Sullivan JL, Weinburg DB, Gidmark S, Engle RL, Parker VA, Tyler DA. Collaborative capacity and patient-centered care in the Veterans' Health Administration Community Living Centers. INTERNATIONAL JOURNAL OF CARE COORDINATION 2019; 22:90-99. [PMID: 32670596 DOI: 10.1177/2053434519858028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Previous research in acute care settings has shown that collaborative capacity, defined as the way providers collaborate as equal team members, can be improved by the ways in which an organization supports its staff and teams. This observational cross-sectional study examines the association between collaborative capacity and supportive organizational context, supervisory support, and person-centered care in nursing homes to determine if similar relationships exist. Methods We adapted the Care Coordination Survey for nursing homes and administered it to clinical staff in 20 VA Community Living Centers. We used random effects models to examine the associations between supportive organizational context, supervisory support, and person-centered care with collaborative capacity outcomes including quality of staff interactions, task independence, and collaborative influence. Results A total of 723 Community Living Center clinical staff participated in the Care Coordination Survey resulting in a response rate of 29%. We found that teamwork and collaboration-measured as task interdependence, quality of interactions and collaborative influence-did not differ significantly between Community Living Centers but did differ significantly across occupational groups. Moreover, staff members' experiences of teamwork and collaboration were positively associated with supportive organizational context and person-centered care. Discussion Our findings suggest that elements of organizational context are important to facilitating collaborative capacity. Additionally, investing in staffing, rewards, and person-centered care may improve teamwork.
Collapse
Affiliation(s)
- Jennifer L Sullivan
- Center for Healthcare Organization and Implemenation Research, VA Boston Healthcare System, USA.,Boston University, USA
| | | | | | - Ryann L Engle
- Center for Healthcare Organization and Implemenation Research, VA Boston Healthcare System, USA
| | | | | |
Collapse
|
11
|
Molinari V. Long Term Care for Geriatric Health Care Professionals. Clin Gerontol 2019; 42:213-215. [PMID: 30990374 DOI: 10.1080/07317115.2019.1598057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
12
|
Yamamoto-Mitani N, Saito Y, Takaoka M, Takai Y, Igarashi A. Nurses' and Care Workers' Perception of Care Quality in Japanese Long-Term Care Wards: A Qualitative Descriptive Study. Glob Qual Nurs Res 2018; 5:2333393618812189. [PMID: 30547055 PMCID: PMC6287313 DOI: 10.1177/2333393618812189] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 10/11/2018] [Accepted: 10/18/2018] [Indexed: 12/26/2022] Open
Abstract
Despite the growing importance of long-term care for older adults, there has been limited attention to its quality assurance issues in Japan. To start planning the initiation of continuous quality improvement in long-term care hospitals, we explored how nurses and care workers themselves perceived current approaches to quality assurance and improvement on their ward. We interviewed 16 licensed nurses and nine care workers, transcribed and analyzed data using qualitative content analysis techniques, and derived six categories: keeping clients alive is barely possible, the absence of a long-term care practice model, the lack of quality indicators, long-term care hospitals as places for castaways, client quality of life as a source of satisfaction, and conflict between staff and client well-being. To develop continuous quality improvement in Japanese long-term care hospitals, it may be first necessary to introduce a practice model of long-term care and mechanisms to evaluate quality.
Collapse
Affiliation(s)
| | | | | | - Yukari Takai
- Gunma Prefectural Healthcare University, Maebashi, Japan
| | | |
Collapse
|
13
|
Sullivan JL, Engle RL, Tyler D, Afable MK, Gormley K, Shwartz M, Adjognon O, Parker VA. Is Variation in Resident-Centered Care and Quality Performance Related to Health System Factors in Veterans Health Administration Nursing Homes? INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2018; 55:46958018787031. [PMID: 30047811 PMCID: PMC6073824 DOI: 10.1177/0046958018787031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this research was to explore and compare common health system factors for 5 Community Living Centers (ie Veterans Health Administration nursing homes) with high performance on both resident-centered care and clinical quality and for 5 Community Living Centers (CLC) with low performance on both resident-centered care and quality. In particular, we were interested in “how” and “why” some Community Living Centers were able to deliver high levels of resident-centered care and high quality of care, whereas others did not demonstrate this ability. Sites were identified based on their rankings on a composite quality measure calculated from 28 Minimum Data Set version 2.0 quality indicators and a resident-centered care summary score calculated from 6 domains of the Artifacts of Culture Change Tool. Data were from fiscal years 2009-2012. We selected high- and low-performing sites on quality and resident-centered care and conducted 12 in-person site visits in 2014-2015. We used systematic content analysis to code interview transcripts for a priori and emergent health system factor domains. We then assessed variations in these domains across high and low performers using cross-site summaries and matrixes. Our final sample included 108 staff members at 10 Veterans Health Administration CLCs. Staff members included senior leaders, middle managers, and frontline employees. Of the health system factors identified, high and low performers varied in 5 domains, including leadership support, organizational culture, teamwork and communication, resident-centered care recognition and awards, and resident-centered care training. Organizations must recognize that making improvements in the factors identified in this article will require dedicated resources from leaders and support from staff throughout the organization.
Collapse
Affiliation(s)
- Jennifer L Sullivan
- 1 Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, MA, USA.,2 Boston University, MA, USA
| | - Ryann L Engle
- 1 Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, MA, USA
| | - Denise Tyler
- 3 RTI International, Waltham, MA, USA.,4 Brown University, Providence, RI, USA
| | | | - Katelyn Gormley
- 1 Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, MA, USA
| | - Michael Shwartz
- 1 Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, MA, USA.,2 Boston University, MA, USA
| | - Omonyêlé Adjognon
- 1 Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, MA, USA
| | - Victoria A Parker
- 1 Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, MA, USA.,5 University of New Hampshire, Durham, NH
| |
Collapse
|