Dissemination and Implementation of Function Focused Care for Assisted Living

 描述(由申请人提供)：辅助生活(AL)环境为需要日常生活活动(ADL)或工具性ADL(例如药物管理)帮助但不需要24小时护理的个人提供家庭式环境。在AL环境中，近40%的居民需要三种或三种以上ADL的帮助，大多数人需要帮助准备膳食和药物管理。他们往往会经历更多的功能衰退，比在护理机构的居民花更少的体力活动时间。这种下降并不完全与疾病的进展有关。相反，这是由于 提供护理的方式以及照顾者必须为居民执行护理任务的倾向，而不是允许他或她进行活动。此外，老年人、家庭和照顾者过度担心从事体力活动会导致不良事件(如跌倒)。居民功能和体力活动的持续减少实际上增加了他们跌倒、疼痛、压疮、进一步功能下降、住院疗养院安置和生活质量下降的风险。以功能为中心的急性白血病护理(FFC-AL)是一种帮助居民全天参与功能和身体活动的护理方法。FFC-AL是一种基于四个步骤的理论方法，包括：(1)环境和政策评估；(2)教育；(3)建立驻地服务计划；(4)指导和激励直接护理工作者和居民。在疗效试验中，FFC-AL由一名研究护士协调人与一名确定的设置冠军一起在12个月内实施。暴露在FFC-AL环境中的居民保持或改善了功能，在体力活动上花费了更多的时间，并且不太可能被转移到急性护理机构。不幸的是，由于环境和居民相关因素的影响，在AL环境中实施像FFC-AL这样的有效护理方法是具有挑战性的。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，包括设置利益攸关方的参与，使用AL设置中现有的资源，并允许个性化地专注于设置具体的挑战。这项研究将在马里兰州、宾夕法尼亚州和马萨诸塞州的96个AL环境中测试FFC-AL-EIT的传播和实施情况，并将包括960名居民。将使用REACH、有效性、采用、实施和维护(RE-AIM)模式来评估成果。通过使用基于理论的方法和建立在传播和实施以功能为重点的护理方面的先前经验，这项研究将增加关于AL环境中有效干预的传播和实施的已知情况，并作为其他护理方法的典范。

 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.