Impact of Intervention to Improve Nursing Home Resident-Staff Interactions and Engagement
Impact of Intervention to Improve Nursing Home Resident-Staff Interactions and Engagement
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DOI：
10.1093/geront/gny039
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发表时间：
2018-08-01
期刊：
影响因子：
5.7
通讯作者：
Snow, Andrea Lynn
中科院分区：
文献类型：
--
作者：
Hartmann, Christine W.;Mills, Whitney L.;Snow, Andrea Lynn
背景和目的：对于养老院居民来说，与工作人员的积极互动和对日常生活的参与对提高生活质量有重要意义。我们试图在六个退伍军人健康管理疗养院(如社区生活中心-CLC)的机会性滚雪球样本中改善以人为中心的护理的这些方面，使用针对员工行为改变的干预措施，重点改善住院医生和员工之间的互动，从而最终旨在改善住院医生的敬业度。研究设计和方法：我们将这项混合方法研究建立在行为改变的能力、机会、动机、行为(COM-B)模型的基础上。我们通过以下方式实施了干预措施：(A)使用一套循证做法来实施质量改进；(B)将主要以《中图法》为基础的工作人员便利化与一些研究便利化相结合。有效的居民和工作人员调查和干预前后收集的结构化观察，以及干预后进行的半结构化工作人员访谈，有助于评估干预成功。结果：62名CLC居民和308名工作人员回答了调查。研究人员进行了1490次离散观察。干预措施的实施与工作人员在提供直接护理期间与居民的沟通增加有关，并减少了工作人员与居民的负面互动。在66次访谈中，工作人员一致认为，干预措施帮助他们(A)提高了对确定参与机会的重要性的认识，(B)采取行动改善居民与工作人员之间的互动质量。讨论和影响：事实证明，干预措施是可行的，并影响了工作人员对其行为进行简单改进，改善了驻地工作人员与工作人员的互动和工作人员评估的驻地工作人员的参与度。
Background and Objectives: For nursing home residents, positive interactions with staff and engagement in daily life contribute meaningfully to quality of life. We sought to improve these aspects of person-centered care in an opportunistic snowball sample of six Veterans Health Administration nursing homes (e.g., Community Living Centers-CLCs) using an intervention that targeted staff behavior change, focusing on improving interactions between residents and staff and thereby ultimately aiming to improve resident engagement.Research Design and Methods: We grounded this mixed-methods study in the Capability, Opportunity, Motivation, Behavior (COM-B) model of behavior change. We implemented the intervention by (a) using a set of evidence-based practices for implementing quality improvement and (b) combining primarily CLC-based staff facilitation with some researcherled facilitation. Validated resident and staff surveys and structured observations collected pre and post intervention, as well as semi-structured staff interviews conducted post intervention, helped assess intervention success.Results: Sixty-two CLC residents and 308 staff members responded to the surveys. Researchers conducted 1,490 discrete observations. Intervention implementation was associated with increased staff communication with residents during the provision of direct care and decreased negative staff interactions with residents. In the 66 interviews, staff consistently credited the intervention with helping them (a) develop awareness of the importance of identifying opportunities for engagement and (b) act to improve the quality of interactions between residents and staff.Discussion and Implications: The intervention proved feasible and influenced staff to make simple enhancements to their behaviors that improved resident-staff interactions and staff-assessed resident engagement.