Testing a Restorative Care Nursing Program

描述（由申请人提供）：大多数住在养老院的老年人在日常生活活动（ADL）方面需要一些帮助。功能障碍的原因有很多，在这些护理中，老年人会产生依赖性，缺乏自我护理活动的动力。然而，恢复性护理是一种注重恢复和/或维持身体功能的护理哲学，并帮助老年人补偿功能障碍，以获得最高水平的功能。恢复性护理强调预防身体依赖、不活动和不活动的继发性后遗症。虽然有一些关于这些计划的好处的轶事报道（Koroknay等人，1995;north, 1991; Farnham & Moffett, 1988），但很少有定量证据支持这些计划的广泛使用，也很少有详细描述和开发的计划。本研究的主要目的是实施研究者开发的两层恢复性护理计划，即护理助理住院护理活动干预（NARCAI）。NARCAI结合了基于自我效能的干预措施，为护理助理和住院医师改善功能表现，维持或减少挛缩次数，维持或改善肌肉力量，减少跌倒和跌倒相关伤害，并改善长期护理住院医师的生活质量。与住院医师相关的次要目标是了解住院医师从事功能活动的机制，即自我效能感和结果预期的中介作用。护理助理的次要目标是了解护理助理改变行为以促进恢复性护理活动的机制，以及NARCAI如何影响护理助理在恢复性护理活动中的表现、就业状况和工作满意度。埃里克森生活护理社区拥有和管理的8家长期护理机构共有520名居民和560名护理助理将参与研究。这些设施将被随机分配接受NARCAI或常规护理。将对协方差进行2（组）× 3（时间）重复测量分析，以解决主要和次要目标。测试将在项目实施后的基线、4个月和12个月进行。这项研究将有助于确定恢复性护理计划的有效性，并为如何将这些计划整合到所有长期护理设施中提供一个现实的模型。最终目标是改变目前长期护理的护理理念，关注功能，改善临床结果，并告知决策者恢复性护理计划的有效性。

DESCRIPTION (provided by applicant): The majority of older adults living in nursing homes require some assistance with activities of daily living (ADL). There are many causes of functional impairments, among these nursing care that create dependency and lack of motivation on the part of the older adult to perform self-care activities. Restorative care, however, is a philosophy of care that focuses on the restoration and/or maintenance of physical function, and helps the older adult to compensate for functional impairments so that the highest level of function is obtained. Restorative care places an important emphasis on prevention of the secondary sequelae of physical dependence, inactivity, and immobility. Although there are some anecdotal reports of benefits of these programs (Koroknay et al., 1995; Orth, 1991; Farnham & Moffett, 1988), there is little quantitative evidence to support the widespread use of these programs, and few well described and developed programs. The primary aims of this study are to implement an investigator developed two tiered restorative care program, the Nursing Assistants Resident Care Activities Intervention (NARCAI). The NARCAI incorporates self-efficacy based interventions for both nursing assistants and residents to improve functional performance, maintain or decrease the number of contractures, maintain or improve muscle strength, decreased falls and fall related injuries, and improve quality of life in long-term care residents. The secondary aims related to residents focus on understanding the mechanism by which residents engage in functional activities, i.e. the mediating effect of self- efficacy and outcome expectations. The secondary aims related to nursing assistants focus on understanding the mechanism by which nursing assistants change behavior to facilitate restorative care activities, and how the NARCAI impacts nursing assistants performance of restorative care activities, employment status and job satisfaction. A total of 520 residents and 560 nursing assistants in 8 long-term care facilities owned and managed by Erickson Life Care Communities will participate in the study. The facilities will be randomly assigned to receive the NARCAI or routine care. A 2(group) by 3(time) repeated measure analysis of covariance will be done to address both the primary and secondary aims. Testing will be done at baseline, 4 and 12 months following implementation of the program. This study will help determine the effectiveness of restorative care programs and provide a realistic model for how to integrate these programs into all long-term care facilities. The ultimate goal is to alter the current philosophy of care in long-term care to focus on function, improve clinical outcomes, and inform policy makers on the effectiveness of restorative care programs.