School of Graduate Psychology, Pacific University, Hillsboro, OR, USA.
VA Center for Integrated Healthcare (CIH), Western New York Healthcare System, Batavia, NY, USA.
J Am Med Dir Assoc. 2023 Jul;24(7):1035-1041. doi: 10.1016/j.jamda.2023.03.037. Epub 2023 May 6.
The Veterans Health Administration (VA) STAR-VA program is a person-centered, interdisciplinary intervention for managing distress behaviors in dementia in VA nursing homes, called Community Living Centers (CLCs). Teams often struggle to sustain STAR-VA after site-lead partner turnover. The STAR-VA Sustainment Coaching Program was developed to support a new local STAR-VA behavioral coordinator and/or nurse champion (ie, site-leads) and engage the team to implement sustainment strategies. The aims of this evaluation were to document sustainment needs, barriers and facilitators, and effective strategies used during a sustainment intervention.
We describe qualitative and quantitative findings of a program evaluation of the STAR-VA Sustainment Coaching pilot program.
Eight CLC teams participated in the pilot program, 5 training a new nurse champion, 2 a new behavioral coordinator, and 1 both new site-leads.
CLC teams completed a needs assessment, developed sustainment goals and plans, tracked sustainment interventions implemented, and reported case outcomes. Outcome assessment and tracking reports were summarized and themes identified using a qualitative inductive approach.
Common sustainment needs were to train a new nurse champion, promote staff understanding of dementia and distress behaviors, and promote a culture of person-centered dementia care. Most sites selected sustainment goals of implementing training procedures and behavioral rounds. Sustainment barriers included limited staff time, staff turnover, lack of supportive routines and tools, and limited awareness of STAR-VA. Facilitators included leadership support, staff interest, and training resources. Most sites reported successful implementation of STAR-VA behavior rounds, whereas strategies to achieve training-related goals had variable success.
The STAR-VA Sustainment Coaching Program helped CLC teams identify and implement strategies to support sustained STAR-VA implementation. The results of this project are informing ongoing efforts to integrate STAR-VA components into usual care processes for CLC residents with dementia.
退伍军人健康管理局（VA）的 STAR-VA 项目是一项以人为本的跨学科干预措施，用于管理退伍军人事务部护理之家（称为社区生活中心，CLC）中痴呆症患者的困扰行为。团队在新的现场领导合作伙伴更替后，往往难以维持 STAR-VA。STAR-VA 维持教练计划旨在为新的当地 STAR-VA 行为协调员和/或护士冠军（即现场领导者）提供支持，并使团队参与实施维持策略。本评估的目的是记录维持需求、障碍和促进因素，以及在维持干预过程中使用的有效策略。
我们描述了 STAR-VA 维持教练试点计划的计划评估的定性和定量发现。
八个 CLC 团队参加了试点计划，其中 5 个培训新的护士冠军，2 个培训新的行为协调员，1 个同时培训新的现场领导者。
CLC 团队完成了需求评估，制定了维持目标和计划，跟踪实施的维持干预措施，并报告病例结果。使用定性归纳方法总结了结果评估和跟踪报告，并确定了主题。
常见的维持需求是培训新的护士冠军，提高员工对痴呆症和困扰行为的理解，以及促进以人为本的痴呆症护理文化。大多数站点选择了实施培训程序和行为轮次的维持目标。维持障碍包括员工时间有限、员工流动、缺乏支持性常规和工具，以及对 STAR-VA 的认识有限。促进因素包括领导力支持、员工兴趣和培训资源。大多数站点报告成功实施了 STAR-VA 行为轮次，而实现培训相关目标的策略则取得了不同程度的成功。
STAR-VA 维持教练计划帮助 CLC 团队确定并实施了支持持续实施 STAR-VA 的策略。该项目的结果正在为将 STAR-VA 组件纳入 CLC 居民痴呆症常规护理过程提供信息。
