Estabrooks Carole A, Squires Janet E, Hayduk Leslie, Morgan Debra, Cummings Greta G, Ginsburg Liane, Stewart Norma, McGilton Katherine, Kang Sung Hyun, Norton Peter G
Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
J Am Med Dir Assoc. 2015 Jun 1;16(6):537.e1-10. doi: 10.1016/j.jamda.2015.03.009. Epub 2015 Apr 17.
This study assessed individual and organizational context (work environment) factors that influence use of best practices by care aides (nursing assistants) in nursing homes. Little scientific attention has been focused on understanding best practice use in nursing homes and almost none on care aides.
A total of 1262 care aides in 25 nursing homes in the 3 Canadian prairie provinces. Care aides are unregulated workers who provide 80% of direct care to residents in Canadian nursing homes.
We used hierarchical linear modeling to (1) assess the amount of variance in use of best practices, as reported by care aides, that could be attributed to individual or organizational factors, and (2) identify predictors of best practices use by care aides.
At the individual level, statistically significant predictors of instrumental use of best practices included sex, age, shift worked, job efficacy, and belief suspension. At the unit level, significant predictors were social capital, organizational slack (staffing and time), number of informal interactions, and unit type. At the facility level, ownership model and province were significant. Significant predictors of conceptual use of best practices at the individual level included English as a first language, job efficacy, belief suspension, intent to use research, adequate knowledge, and number of information sources used. At the unit level, significant predictors were evaluation (feedback mechanisms), structural resources, and organizational slack (time). At the facility level, province was significant. The R(2) was 18.3% for instrumental use of best practices and 43.4% for conceptual use. Unit level factors added a substantial amount of explained variance whereas facility level factors added relatively little explained variance.
Our study suggests that context plays an important role in care aides' use of best practices in nursing homes. Individual characteristics played a more prominent role than contextual factors in predicting conceptual use of best practices.
本研究评估了影响养老院护理员（护工）采用最佳实践的个人和组织背景（工作环境）因素。在理解养老院最佳实践的应用方面，很少有科学研究予以关注，而针对护理员的研究几乎没有。
加拿大3个草原省份的25所养老院中的1262名护理员。护理员是未受规范管理的工作人员，在加拿大养老院中为居民提供80%的直接护理服务。
我们使用分层线性模型来（1）评估护理员报告的最佳实践应用差异中可归因于个人或组织因素的部分，以及（2）确定护理员采用最佳实践的预测因素。
在个人层面，最佳实践工具性应用的统计学显著预测因素包括性别、年龄、工作班次、工作效能和信念悬置。在单位层面，显著预测因素是社会资本、组织松弛（人员配备和时间）、非正式互动次数和单位类型。在机构层面，所有权模式和省份具有显著影响。最佳实践概念性应用在个人层面的显著预测因素包括英语为第一语言、工作效能、信念悬置、使用研究的意愿、足够的知识以及使用的信息源数量。在单位层面，显著预测因素是评估（反馈机制）、结构资源和组织松弛（时间）。在机构层面，省份具有显著影响。最佳实践工具性应用的R²为18.3%，概念性应用的R²为43.4%。单位层面因素增加了大量可解释的方差，而机构层面因素增加的可解释方差相对较少。
我们的研究表明，背景在养老院护理员采用最佳实践方面起着重要作用。在预测最佳实践的概念性应用方面，个人特征比背景因素发挥了更突出的作用。
