Nakrem Sigrid, Stensvik Geir-Tore, Skjong Rickard Johan, Ostaszkiewicz Joan
Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), NO-7491, Trondheim, Norway.
Work Environment Unit in Trondheim kommune, Postboks 2300 Torgarden, 7004, Trondheim, Norway.
BMC Health Serv Res. 2019 Mar 27;19(1):191. doi: 10.1186/s12913-019-4034-0.
A majority of nursing home residents have dementia, and many develop neuropsychiatric symptoms. These symptoms are often caused by neuropathological changes in the brain, but modifiable factors related to quality of care also have an impact. A team-based approach to care that include comprehensive geriatric assessments to facilitate clinical decision-making and structured case conference meetings could improve quality of care and quality of life for the residents. Despite recommendations to adopt this approach, dementia care does not reach standards of evidence-based practice. Better implementation strategies are needed to improve care. A cluster randomised controlled trial with a 12-month intervention was conducted, and the experiences of staff from the intervention nursing homes were explored in a qualitative study after the trial was completed. The aim of the present study was to describe: (i) staff's experiences with the intervention consisting of comprehensive geriatric assessments of nursing home residents and case conferencing, and (ii) enablers and barriers to implementing and sustaining the intervention.
Four focus groups with a total of 19 healthcare staff were interviewed, representing four out of eight intervention nursing homes. Thematic content analysis was used to interpret the transcribed data.
Two major themes emerged: 1) learning experiences and 2) enablers and barriers to implementation. The participants had experienced learning both on an organisational level: improvements in care and an organisation that could adjust and facilitate change; and on an individual level: becoming more conscious of residents' needs and acquiring skills in resident assessments. Participants described important enabling factors such as managerial support, drivers for change, and feasibility of the intervention for the local nursing home. Barriers to implementing and sustaining the intervention were time constraints, lack of staff training, unsuitable electronic patient record system for care planning and high complexities of care and instabilities that are present in nursing homes.
Quality improvements in nursing homes are difficult to sustain. In order to offer residents high quality of care that meet their individual needs, it is important for management and nursing home staff to be aware of and understand factors that enable or constrain change.
大多数养老院居民患有痴呆症，许多人还会出现神经精神症状。这些症状通常由大脑的神经病理变化引起，但与护理质量相关的可改变因素也有影响。一种以团队为基础的护理方法，包括进行全面的老年评估以促进临床决策以及组织结构化的病例讨论会，可能会提高居民的护理质量和生活质量。尽管有建议采用这种方法，但痴呆症护理并未达到循证实践的标准。需要更好的实施策略来改善护理。开展了一项为期12个月干预的整群随机对照试验，并在试验完成后通过定性研究探索了干预养老院工作人员的经验。本研究的目的是描述：（i）工作人员对由养老院居民全面老年评估和病例讨论组成的干预措施的体验，以及（ii）实施和维持该干预措施的促进因素和障碍。
对来自八个干预养老院中的四个养老院的总共19名医护人员进行了四个焦点小组访谈。采用主题内容分析法对转录数据进行解读。
出现了两个主要主题：1）学习体验和2）实施的促进因素和障碍。参与者在组织层面都有学习体验：护理方面的改善以及一个能够调整并促进变革的组织；在个人层面：更加意识到居民的需求并获得居民评估技能。参与者描述了重要的促进因素，如管理支持、变革驱动因素以及该干预措施对当地养老院的可行性。实施和维持该干预措施的障碍包括时间限制、缺乏工作人员培训、用于护理计划的电子病历系统不合适以及养老院护理的高度复杂性和不稳定性。
养老院的质量改进难以持续。为了为居民提供满足其个人需求的高质量护理，管理层和养老院工作人员意识到并理解促成或限制变革的因素非常重要。
