Dissemination and Implementation of Function Focused Care for Assisted Living

 描述（由申请人提供）：辅助生活（AL）设置为需要日常生活活动（ADL）或工具性ADL（例如，药物管理），但不需要24小时护理。AL环境中近40%的居民需要三种或更多ADL的帮助，并且大多数需要膳食准备和药物管理方面的帮助。他们往往经历更多的功能衰退，花在身体活动的时间比居民在护理设施。这种下降与疾病进展不完全相关。相反，这是由于 提供护理的方式以及护理人员必须为住院医师执行护理任务而不是允许他或她进行活动的趋势。此外，老年人、家庭和护理人员过度担心从事体力活动会导致不良事件（例如，福尔斯）。居民功能和体力活动的持续下降实际上增加了他们福尔斯、疼痛、压疮、进一步功能下降、住院疗养院安置的风险，并降低了生活质量。AL的功能集中护理（FFC-AL）是一种护理方法，帮助居民在一天中参与功能和身体活动。FFC-AL是一个基于理论的四步方法，包括：（1）环境和政策评估;（2）教育;（3）建立居民服务计划;（4）指导和激励直接护理工作者和居民。在疗效试验中，FFC-AL由研究护士促进者与确定的设置冠军合作实施了12个月。暴露于FFC-AL环境中的居民保持或改善了功能，花更多的时间进行体力活动，并且不太可能被转移到急性护理机构。不幸的是，实施有效的护理方法，如FFC-AL到AL设置是具有挑战性的，由于设置和居民相关的因素。为了克服这些挑战，我们开发了一种基于理论的方法，使用社会认知理论，社会生态模型和证据整合三角（EIT）。这种方法，被称为FFC-AL-EIT，包括设置利益相关者的参与，使用AL设置中现有的资源，并允许个性化的重点设置具体的挑战。本研究将测试在马里兰州、宾夕法尼亚州和马萨诸塞州的96个AL环境中传播和实施FFC-AL-EIT，并将包括960名居民。将使用覆盖、有效性、采用、实施和维护（RE-AIM）模型来评价结果。通过使用基于理论的方法和建立在传播和实施功能为重点的护理之前的经验，这项研究将增加什么是已知的传播和实施有效的干预措施，在AL设置和作为其他护理方法的模式。

 DESCRIPTION (provided by applicant): Assisted living (AL) settings provide homelike environments for individuals who need help with activities of daily living (ADL) or instrumental ADLs (e.g., medication management) but for whom 24-hour nursing care is not necessary. Nearly 40% of residents in AL settings require assistance with three or more ADLs and most need help with meal preparation and medication management. They tend to experience even more functional decline and spend less time in physical activity than residents in nursing facilities. This decline is not completely related to disease progression. Rather, it is due to the way care is provided and the tendency caregivers have to perform the care task for the resident rather than allowing him or her to do the activity. In addition, there is an excessive fear among older adults, families and caregivers that engaging in physical activity will result in adverse events (e.g., falls). The persistent decrease in function and physical activity in residents actualy increases their risk for falls, pain, pressure ulcers, further functional decline, hospitalizations nursing home placement, and decreases quality of life. Function Focused Care for AL (FFC-AL) is an approach to care such that residents are helped to participate in functional and physical activity throughout the course of the day. FFC-AL is a four-step theory-based approach including: (1) Environment and Policy Assessments; (2) Education; (3) Establishing Resident Service Plans; and (4) Mentoring and Motivating Direct Care Workers and Residents. In efficacy trials, FFC-AL was implemented over 12 months by a Research Nurse Facilitator working with an identified setting champion. Residents in settings exposed to FFC-AL maintained or improved function, spent more time in physical activity and were less likely to be transferred to acute care facilities. Unfortunately, implementing effective care approaches like FFC-AL into AL settings is challenging due to setting and resident related factors. To overcome these challenges we developed a theory based approach using Social Cognitive Theory, the Social Ecological Model and the Evidence Integration Triangle (EIT). This approach, referred to as FFC-AL-EIT, includes the involvement of setting stakeholders, uses resources currently available in AL settings and allows for an individualized focus on setting specific challenges. This study will test the dissemination and implementation of FFC-AL-EIT across 96 AL settings in Maryland, Pennsylvania and Massachusetts and will include 960 residents. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) model will be used to evaluate outcomes. By using a theory based approach and building off prior experience in disseminating and implementing function focused care, this study will add to what is known about dissemination and implementation of effective interventions in AL settings and serve as a model for other care approaches.