Nursing home staff experiences of implementing mentorship programmes: A systematic review and qualitative meta-synthesis

Leading the way: implementing aged care innovations

OBJECTIVES

The objective of this study was to identify the key characteristics of leaders that support the implementation of innovations in aged care settings.

METHODS

We conducted a secondary analysis of papers from a large scoping review that identified how leaders supported the implementation of innovations in aged care. Once imported into NVivo12, the findings were deductively coded using the domains of Bloom's taxonomy of learning. Each parent code was then inductively analyzed to identify key characteristics within each domain.

RESULTS

Our review identified four types of knowledge, five skills, and six attitudes that leaders should exhibit to better support the implementation of innovations within aged care settings. In addition to our findings regarding Bloom's learning domains, we identified nine leadership behaviors that participants in the included papers perceived as valuable for enhancing the implementation process. Furthermore, we identified four key organizational elements that support leaders in navigating and facilitating the implementation of innovations within aged care settings.

CONCLUSION

Our review identified the characteristics that leaders should demonstrate when supporting the implementation of innovations in aged care. Importantly, our findings also emphasized the changing role of leadership from a hierarchical approach to a more collaborative, supportive, and empowering style. The insights identified in this review will help to guide aged care leaders, stressing the significance of adaptable and relational leadership styles that will guide the implementation of innovations within the aged care sector.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A271.

Factors that influence the implementation of innovation in aged care: a scoping review

OBJECTIVE

The objective of this scoping review is to identify factors that influence the implementation of innovation in aged care.

INTRODUCTION

Aged care is a dynamic sector experiencing rapid change. Implementation of innovations in aged care has received relatively little research attention compared to health care.

INCLUSION CRITERIA

This review included studies of any design, that examined the implementation of innovations in aged care settings.

METHODS

Searches were conducted in MEDLINE, CINAHL, AgeLine, and ProQuest Social Sciences Premium Collection for studies published between January 1, 2012 and December 31, 2022. The titles and abstracts of retrieved citations were screened by two independent reviewers. Full-text articles were screened by one reviewer to determine inclusion. Data were extracted in NVivo using a tool developed by the research team. Factors that influenced implementation were inductively coded, interpreted, and grouped into categories in a series of workshops.

RESULTS

Of the 2530 studies that were screened, 193 were included. Of the included papers, the majority (74%) related to residential aged care, 28% used an implementation theory or framework, and 15% involved consumers. Five key categories of factors influencing implementation were identified: organizational context including resourcing and culture; people's attitudes and capabilities; relationships between people; the intervention and its appropriateness; and implementation actions such as stakeholder engagement and implementation strategies.

CONCLUSIONS

Our findings can be used to develop practical resources to support implementation efforts, and highlight the importance of resourcing for successful implementation. Attention to community-based aged care, and greater engagement with theory and community is needed to promote research rigor, relevance and applicability.

A digital educational resource to support and enhance effective mentorship practices of nursing students in nursing homes: a qualitative study

BACKGROUND

There is a grooving body of evidence emphasising the need to support and enhance effective mentorship practices for nursing students in nursing home placements, including strengthening of the pedagogical competence of registered nurse mentors. Owing to the necessity for multifaceted mentoring competence and the challenges of workload registered nurses are facing, the use of flexible digital educational resources has been suggested. However, current knowledge on the effectiveness of digital educational resources in enhancing mentorship practices in nursing homes is scarce. This study aimed to explore the perception of registered nurse mentors regarding the effectiveness of a digital educational resource, particular its usability and value-in-use in supporting and enhancing mentorship practices in nursing homes.

METHODS

The study applied an exploratory descriptive qualitative design. Pre- and post-mentoring semi-structured focus group interviews were conducted among a total of 23 registered nurse mentors across three Norwegian nursing homes. The transcribed interviews were thematically analysed. Standards for reporting qualitative research were followed.

RESULTS

The analysis yielded one pre-mentoring theme: (1) predominant enthusiasm and satisfaction and three post-mentoring themes: (2) enhanced confidence and motivation, (3) enhanced mentoring competence in supporting the nursing students' learning process, and (4) factors influencing the value-in-use of the digital educational resource.

CONCLUSIONS

Digital educational resources support effective mentorship practices by enhancing the confidence and motivation in the mentor role and by enabling more goal-oriented supervision and assessment tailored to the learning goals of students. The implementation of digital educational resources to support and enhance effective mentorship practices is an important avenue for further research towards achieving high-quality learning environments in clinical nursing education in general and nursing homes. Based on the study findings, nursing educational institutions should consider offering digital educational resources to develop, support, and advance mentorship training, which may more effectively impact and improve the quality of clinical nursing education.

Effectiveness of clinical mentorship program for students of long-term aged care: A mixed-methods study

BACKGROUND

Internationally, the population is rapidly aging with a strong demand for aged care services. In Taiwan, both recruiting and retaining staff to aged care poses difficulties. Good clinical role models can positively impact students' confidence and professional development and influence their willingness to enter the long-term aged care workforce.

OBJECTIVES

To clarify clinical mentors' roles and competencies and assess the effectiveness of a mentorship program for improving students' professional commitment and self-efficacy in long-term aged care.

DESIGN

A mixed-methods study with a quasi-experimental research design and qualitative interviews.

SETTINGS

Purposive sampling was used to recruit long-term aged care professional clinical mentors with preceptor qualifications and nursing and aged care students enrolled in a two-year technical program in a Taiwanese university's gerontology care department.

PARTICIPANTS

Fourteen mentors and 48 students participated. The student control group received regular education; the experimental group received mentorship guidance.

METHODS

This study included three phases. Phase one involved qualitative interviews to identify clinical mentors' roles and competencies. Phase two involved expert panel meetings to establish the clinical mentorship program's content and implementation. Phase three involved the program's evaluation. Quantitative questionnaires were administered before the program and subsequently at 6, 12, and 18 months to assess mentors' effectiveness and students' professional commitment and self-efficacy in long-term aged care. Qualitative focus groups solicited participants' feelings and suggestions for the program.

RESULTS

Clinical mentors' roles and competencies centered on two themes: professional role model and establishing good rapport. Quantitative analysis showed that mentoring effectiveness initially recorded a decline, followed by a subsequent increase. Both groups' professional self-efficacy and commitment followed an increasing trend. While the experimental group's professional commitment score was significantly higher than the control groups, their professional self-efficacy scores did not differ significantly.

CONCLUSIONS

The clinical mentorship program improved students' long-term aged care professional commitment and self-efficacy.

Factors associated with retention intention of Registered Nurses in Korean nursing homes

AIM

To identify the factors associated with retention intention among Registered Nurses in South Korean nursing homes.

BACKGROUND

Although nurses are not mandatory personnel, Korean nursing homes employ Registered Nurses.

INTRODUCTION

Determining the factors related to Registered Nurses' retention intention is important for their job stability and ensure provision of quality care.

METHODS

This mixed-methods study employed a sequential explanatory design. A self-reported questionnaire survey was conducted between May 1 and July 3, 2019, with 155 Registered Nurses providing direct care from 37 nursing homes. In-depth qualitative interviews were conducted with 10 participants from August 1 to September 30, 2019. Data were analyzed using multilevel analysis for quantitative study and thematic analysis for qualitative study.

RESULTS

The participants' average age was 48.48 years. Personal factors related to retention intention were Registered Nurses' role, educational level, and job satisfaction. Institutional factors were ownership, number of beds, and working environment. The qualitative study revealed five themes: "Satisfaction with meaningful relationships," "Potential for professional growth," "Nursing service accompanied by emotional labor," "Poor working environments in nursing homes," and "Unprotected nursing expertise."

DISCUSSION

A nursing home's work environment is related to the Registered Nurses' retention intention. Most Registered Nurses in Korea received low wages, lacked access to career management programs, and experienced emotional labor.

CONCLUSION

This study highlighted the personal and institutional factors related to retention intention among Registered Nurses in South Korean nursing homes.

IMPLICATIONS FOR NURSING AND NURSING POLICY

A law that designates Registered Nurses as an essential nursing home workforce is required. Further, nursing homes should increase the number of Registered Nurses to improve working conditions and thereby job satisfaction. It is also necessary to foster a working environment that facilitates professional development opportunities and job clarity.

Developing effective workforce training to support the long-term care of older adults: A review of reviews

This review of reviews aimed to identify and synthesise evidence to support the design of learning interventions for non-registered practitioners supporting older people in long-term care (people's own homes, hospices or residential/nursing care). Our objectives were to inform the analysis part of the Analysis, Design, Development Implementation and Evaluation framework by finding evidence on the following five components of learning: content, format (teaching strategies and resources/media), structure, contextual factors (barriers and enablers) and measures used when monitoring the effectives of learning. Databases searched included Pro-quest (ASSIA), Scopus, Ovid (PsycINFO, Medline, Embase and Social Policy and Practice), SCIE Online and Cochrane Reviews and reference searching, with the last search being conducted in April 2021. Fifteen papers were identified as eligible for inclusion. Most of the interventions aimed to improve dementia care (n = 10), with others exploring LGBT+ competency (n = 2), or other forms of professional development (n = 3). Common features of effective learning included a multifaceted approach, with in-practice learning being blended with additional implementation strategies (e.g. supervision) and didactic learning/worksheets. An important contextual factor was working within an organisational culture which supported shared learning and reflection. This may also help encourage engagement with training, where staff are unwilling to attend if it may compromise care delivery. Future research should focus on the characteristics of trainers and the structure of learning, with more research being needed in in mental and physical morbidities outside the remit of dementia to improve the overall quality of the social care workforce.

Enablers and barriers to implementing care quality improvement program in nursing homes in China

Objective

To explore the perspectives of key stakeholders on necessary factors to implement care quality improvement program.

Methods

We conducted qualitative descriptive research in eight nursing homes in four major prefecture-level cities of Changsha, Xiangtan, Zhuzhou, and Yueyang. Data of 50 clinical nurses and 64 nurse assistants were included and analyzed. Ethical approval was given by the medical ethics committee of Chinese Clinical Trial Registry (No. ChiCTR-IOC-17013109, https://www.chictr.org.cn/index.aspx). One-to-one interviews were used with the nursing managers, and separate focus group discussions were used with the clinical nurses and nurse assistants. All of the interviews were audio recorded and later transcribed verbatim. In addition, the first author documented the responses of every participant in the field notes during the interviews and focus groups.

Results

The participants’ perspectives were characterized by two main themes: (1) enablers, with four subthemes of “organizational support”, “the evidence-based practice ability”, “proactivity”, “nursing supervision and feedback;” and (2) barriers, with five sub-themes of “low educational background”, “the limitations of self-role orientation”, “resistance to change”, “lack of job motivation”, and “organizational constraints”.

Conclusion

These findings recognize factors at the organizational level, staff level and societal level that are necessary to implement effective mentoring. The results of this study can provide reference for nursing home in improving nursing management quality, formulating, implementing and revising training policies.

Oral health assessment of older adults living in long-term care facilities by non-dental professionals: a systematic review protocol of instruments

INTRODUCTION

Regular oral health assessment among older adults living in long-term care facilities (LTCF) can improve their oral health. Different instruments have been developed and used to evaluate the oral health of institutionalised older people by non-dental professionals. These instruments must demonstrate adequate measurement properties. This systematic review aims to examine the studies describing the instruments employed to assess the oral health of older adults living in LTCF by non-dental professionals. The study will also evaluate the measurement properties of such instruments using the checklist proposed by the Consensus-based Standards to select health Measurement Instruments (COSMIN).

METHODS AND ANALYSIS

Studies describing the development of instruments for assessing oral health of institutionalised older adults by non-dental professionals will be included. Studies assessing at least one measurement property (validity, reliability or responsiveness) will be also considered. Electronic searches will be conducted on MEDLINE (PubMed, Ovid), Embase, Web of Science, Scopus and LILACS databases. Two independent reviewers will select the studies and will extract data concerning the characteristics of the research and the instrument. The measurement properties will be evaluated using the COSMIN checklist. The Grading of Recommendations, Assessment, Development and Evaluation approach will be used to grade the quality (or certainty) of evidence and strength of recommendations.

ETHICS AND DISSEMINATION

No ethical approval is required. The results will be submitted for publication to a peer-review journal and presented at relevant conferences.

PROSPERO REGISTRATION NUMBER

CRD42020191479.

Care workers' perspectives of factors affecting a sustainable aged care workforce

AIMS

To identify the reasons why workers decide to enter, stay or leave the aged care workforce; and the factors influencing them to transition between community and residential sectors in Australia.

BACKGROUND

Factors affecting the recruitment and retention of suitable care workers in aged care are complex and influenced by personal, institutional and societal factors.

METHODS

A qualitative description study design.

RESULTS

In total, 32 staff participated in the study. Five main themes were identified: entering aged care with a passion for the job; entering aged care as it is the only employment option; factors attracting care workers to stay in aged care; factors influencing care workers to leave the job; and preferring to work in residential aged care rather than community aged care.

CONCLUSION

Issues relating to the attraction and retention of aged care workers are influenced by personal, institutional and societal factors. Critical shortages in the aged care workforce make the industry more susceptible to crises such as COVID-19 outbreaks.

IMPLICATION FOR NURSING PRACTICE

Aged care organizations need to create a positive psychosocial work environment for staff to improve the attraction and retention of skilled care workers. They also need to develop staff recruitment guidelines to ensure care workers with the appropriate skills and training and a passion for working with older adults are selected. Staff development programmes need to focus on learning activities that enable staff to build peers support in the work environment.

IMPLICATIONS FOR HEALTH POLICY

There is a need to mandate curriculum to enable nursing students to receive more gerontological education and exposure to aged care throughout their education. Aged care quality standards need to mandate transition support for new graduate nurses.

Challenges and opportunities for the multicultural aged care workforce: A systematic review and meta-synthesis

AIMS

To identify (a) the challenges for multicultural aged care teams; (b) the opportunities to facilitate teamwork; and (c) the strategies to assist team members in a multicultural work environment.

BACKGROUND

High-income countries have an increasingly culturally diverse aged care workforce. Fostering teamwork in such an environment is challenging.

METHODS

This systematic review of qualitative studies followed the Joanna Briggs Institute (JBI) meta-aggregation approach. Six databases were searched. Retrieved articles were screened by two reviewers. This review identified 111 findings that were aggregated into 15 categories and five themes.

FINDINGS

Aged care workers' awareness of cultural diversity varies, and their knowledge of each other's cultural background is limited. However, cultural skills are demonstrated, contributing to teamwork. Their experience in cross-cultural encounters is broad, and enhanced team cohesion is desired.

CONCLUSIONS

The cultural competence of the aged care workforce shapes team building, peer support opportunities and positive cross-cultural experiences.

IMPLICATIONS FOR NURSING MANAGEMENT

Recommendations are provided for the adaptation of aged care workers to culturally diverse teams, fostering teamwork to enhance care outcomes for clients. Interventions for improvements in cross-cultural leadership and management, and staff experience of cross-cultural encounters are much needed.

Nursing home staff experiences of implementing mentorship programmes: A systematic review and qualitative meta-synthesis

Aim

To determine nursing home staff experiences in mentorship programmes, and staff perceptions of the enablers and barriers to implement mentorship programmes.

Background

Mentorship programmes are perceived as playing an important role in improving the quality of care in nursing homes. However, little is known about research evidence across the global about staff's experiences in the programmes.

Methods

A search for studies published from the earliest available date to April 2019 was undertaken. Two reviewers performed data extraction and an appraisal of eight studies using tools from the Joanna Briggs Institute. A pragmatic meta‐aggregative approach was applied to synthesise the findings. The qualitative research that was included was analysed to identify 63 findings that were organised into 12 categories and combined into three syntheses.

Results

The implementation of effective mentorship programmes is influenced by three factors: mentor capability, opportunity in the mentorship programmes, and motivation in the mentorship programmes.

Conclusions

There are a number of studies of nursing home staff experiences of mentorship programmes. However, systematic reviews that synthesise findings in this field are lacking. It is crucial to tailor the programme design to suit each unique nursing home care setting. We identified barriers and enablers, and learned that no barriers are insurmountable.

Implications for Nursing Management

Findings will inform nurse managers of an ideal environment for the implementation of a successful mentorship programme. Nursing homes need to establish and sustain mentorship programmes to help improve workforce capacity in delivering high‐quality care for residents.