Resident-Directed Long-Term Care: Staff Provision of Choice During Morning Care
Resident-Directed Long-Term Care: Staff Provision of Choice During Morning Care
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DOI：
10.1093/geront/gnr066
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发表时间：
2011-12-01
期刊：
影响因子：
5.7
通讯作者：
Schnelle, John F.
中科院分区：
文献类型：
--
作者：
Simmons, Sandra F.;Rahman, Annie;Schnelle, John F.
目的：制定观察方案来评估与选择相关的工作人员与住院医师沟通的质量，并描述工作人员与住院医师的互动，作为该工具用于评估与在早晨护理提供期间提供选择相关的当前疗养院实践的有用性的初步证据。设计和方法：本研究包括 2 个设施中的 73 名长期居住居民。研究人员在有针对性的护理活动（起床、失禁、穿衣和就餐地点）期间连续4个小时进行观察。连续 12 周每周进行一次观察。工作人员与居民的互动是根据工作人员的选择和居民的反应来衡量的。结果：对于工作人员的选择提议（kappa = .83，p < .001）、提供的选择类型（kappa = .75，p < .001）以及与选择相关的居民请求（kappa = .72，p < .001）的衡量指标达成了评估者间的一致。对晨间护理 4 个方面的 2,766 次护理事件的观察表明，工作人员在 18% 的事件中为居民提供了选择。大多数观察结果（70%）被编码为工作人员“别无选择”。启示：疗养院工作人员可以使用这种标准化观察工具的简化版本来可靠地测量与早晨护理提供期间的选择相关的工作人员与住院医师的互动，作为改善住院医师导向的护理实践的第一步。
Purpose: To develop an observational protocol to assess the quality of staff-resident communication relevant to choice and describe staff-resident interactions as preliminary evidence of the usefulness of the tool to assess current nursing home practices related to offering choice during morning care provision. Design and Methods: This study included 73 long-stay residents in 2 facilities. Research staff conducted observations for 4 consecutive morning hours during targeted care activities (transfer out of bed, incontinence, dressing, and dining location). Observations were conducted weekly for 12 consecutive weeks. Staff-resident interactions were measured related to staff offers of choice and residents' responses. Results: Interrater agreement was achieved for measures of staff offers of choice (kappa = .83, p < .001), type of choice provided (kappa = .75, p < .001), and resident requests related to choice (kappa = .72, p < .001). Observations over 2,766 care episodes during 4 aspects of morning care showed that staff offered residents choice during 18% of the episodes. Most observations (70%) were coded as staff offering "no choice." Implications: Nursing home staff can use a simplified version of this standardized observational tool to reliably measure staff-resident interactions related to choice during morning care provision as a first step toward improving resident-directed care practice.