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A systematic review of interventions to change staff care practices in order to improve resident outcomes in nursing homes

Journal Article


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Abstract


  • Background

    We systematically reviewed interventions that attempted to change staff practice to improve long-term care resident outcomes.

    Methods

    Studies met criteria if they used a control group, included 6 or more nursing home units and quantitatively assessed staff behavior or resident outcomes. Intervention components were coded as including education material, training, audit and feedback, monitoring, champions, team meetings, policy or procedures and organizational restructure.

    Results

    Sixty-three unique studies were broadly grouped according to clinical domain—oral health (3 studies), hygiene and infection control (3 studies), nutrition (2 studies), nursing home acquired pneumonia (2 studies), depression (2 studies) appropriate prescribing (7 studies), reduction of physical restraints (3 studies), management of behavioral and psychological symptoms of dementia (6 studies), falls reduction and prevention (11 studies), quality improvement (9 studies), philosophy of care (10 studies) and other (5 studies). No single intervention component, combination of, or increased number of components was associated with greater likelihood of positive outcomes. Studies with positive outcomes for residents also tended to change staff behavior, however changing staff behavior did not necessarily improve resident outcomes. Studies targeting specific care tasks (e.g. oral care, physical restraints) were more likely to produce positive outcomes than those requiring global practice changes (e.g. care philosophy). Studies using intervention theories were more likely to be successful. Program logic was rarely articulated, so it was often unclear whether there was a coherent connection between the intervention components and measured outcomes. Many studies reported barriers relating to staff (e.g. turnover, high workload, attitudes) or organizational factors (e.g. funding, resources, logistics).

    Conclusion

    Changing staff practice in nursing homes is possible but complex. Interventionists should consider barriers and feasibility of program components to impact on each intended outcome.

Authors


  •   Low, Lee-Fay (external author)
  •   Fletcher, Jennifer (external author)
  •   Goodenough, Belinda J.
  •   Jeon, Yun-Hee (external author)
  •   Etherton-Beer, Christopher (external author)
  •   MacAndrew, Margaret (external author)
  •   Beattie, Elizabeth (external author)

Publication Date


  • 2015

Citation


  • Low, L., Fletcher, J., Goodenough, B., Jeon, Y., Etherton-Beer, C., MacAndrew, M. & Beattie, E. (2015). A systematic review of interventions to change staff care practices in order to improve resident outcomes in nursing homes. PLoS One, 10 (11), e0140711-1-e0140711-60.

Scopus Eid


  • 2-s2.0-84955517730

Ro Full-text Url


  • http://ro.uow.edu.au/cgi/viewcontent.cgi?article=4348&context=smhpapers

Ro Metadata Url


  • http://ro.uow.edu.au/smhpapers/3325

Start Page


  • e0140711-1

End Page


  • e0140711-60

Volume


  • 10

Issue


  • 11

Abstract


  • Background

    We systematically reviewed interventions that attempted to change staff practice to improve long-term care resident outcomes.

    Methods

    Studies met criteria if they used a control group, included 6 or more nursing home units and quantitatively assessed staff behavior or resident outcomes. Intervention components were coded as including education material, training, audit and feedback, monitoring, champions, team meetings, policy or procedures and organizational restructure.

    Results

    Sixty-three unique studies were broadly grouped according to clinical domain—oral health (3 studies), hygiene and infection control (3 studies), nutrition (2 studies), nursing home acquired pneumonia (2 studies), depression (2 studies) appropriate prescribing (7 studies), reduction of physical restraints (3 studies), management of behavioral and psychological symptoms of dementia (6 studies), falls reduction and prevention (11 studies), quality improvement (9 studies), philosophy of care (10 studies) and other (5 studies). No single intervention component, combination of, or increased number of components was associated with greater likelihood of positive outcomes. Studies with positive outcomes for residents also tended to change staff behavior, however changing staff behavior did not necessarily improve resident outcomes. Studies targeting specific care tasks (e.g. oral care, physical restraints) were more likely to produce positive outcomes than those requiring global practice changes (e.g. care philosophy). Studies using intervention theories were more likely to be successful. Program logic was rarely articulated, so it was often unclear whether there was a coherent connection between the intervention components and measured outcomes. Many studies reported barriers relating to staff (e.g. turnover, high workload, attitudes) or organizational factors (e.g. funding, resources, logistics).

    Conclusion

    Changing staff practice in nursing homes is possible but complex. Interventionists should consider barriers and feasibility of program components to impact on each intended outcome.

Authors


  •   Low, Lee-Fay (external author)
  •   Fletcher, Jennifer (external author)
  •   Goodenough, Belinda J.
  •   Jeon, Yun-Hee (external author)
  •   Etherton-Beer, Christopher (external author)
  •   MacAndrew, Margaret (external author)
  •   Beattie, Elizabeth (external author)

Publication Date


  • 2015

Citation


  • Low, L., Fletcher, J., Goodenough, B., Jeon, Y., Etherton-Beer, C., MacAndrew, M. & Beattie, E. (2015). A systematic review of interventions to change staff care practices in order to improve resident outcomes in nursing homes. PLoS One, 10 (11), e0140711-1-e0140711-60.

Scopus Eid


  • 2-s2.0-84955517730

Ro Full-text Url


  • http://ro.uow.edu.au/cgi/viewcontent.cgi?article=4348&context=smhpapers

Ro Metadata Url


  • http://ro.uow.edu.au/smhpapers/3325

Start Page


  • e0140711-1

End Page


  • e0140711-60

Volume


  • 10

Issue


  • 11