Department of Medicine - Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.
School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
Int J Older People Nurs. 2023 Sep;18(5):e12563. doi: 10.1111/opn.12563. Epub 2023 Aug 10.
Communities of practice (CoPs) have the potential to help address the residential aged care system's need for continuing education and quality improvement. CoPs have been used in healthcare to improve clinical practice; however, little is known about their application to the unique residential aged care context.
This rapid review of CoPs for residential aged care was conducted to summarise the features of CoPs, how they are developed and maintained, and assess their effectiveness.
MEDLINE and CINAHL databases were searched for studies published from January 1991 to November 2022 about CoPs in residential aged care. Data were extracted regarding the CoPs' three key features of 'domain', 'community' and 'practice' as described by Wenger and colleagues. Kirkpatrick's four levels of evaluation (members' reactions, learning, behaviour and results) was used to examine studies on the effectiveness of CoPs. The Mixed Methods Appraisal Tool was used for quality appraisal.
Nineteen articles reported on 13 residential aged care CoPs. Most CoPs aimed to improve care quality (n = 9, 69%) while others aimed to educate members (n = 3, 23%). Membership was often multidisciplinary (n = 8, 62%), and interactions were in-person (n = 6, 46%), online (n = 3, 23%) or both (n = 4, 31%). Some CoPs were developed with the aid of a planning group (n = 4, 31%) or as part of a larger collaborative (n = 4, 31%), and were maintained using a facilitator (n = 7, 54%) or adapted to member feedback (n = 2, 15%). Thirteen (81%) studies evaluated members' reactions, and three (24%) studies assessed members' behaviour. The heterogeneity of studies and levels of reporting made it difficult to synthesise findings.
This review revealed the variation in why, and how, CoPs have been used in residential aged care, which is consistent with previous reviews of CoPs in healthcare. While these findings can inform the development of CoPs in this context, further research is needed to understand how CoPs, including the membership makeup, delivery mode, facilitator type and frequency of meetings, impact quality of care.
实践社区（CoPs）有可能帮助满足住宅老年护理系统对继续教育和质量改进的需求。CoPs 已在医疗保健领域用于改善临床实践；然而，对于其在独特的住宅老年护理环境中的应用，人们知之甚少。
本项针对住宅老年护理的 CoPs 快速审查旨在总结 CoPs 的特征、其发展和维持方式，并评估其效果。
检索 1991 年 1 月至 2022 年 11 月 MEDLINE 和 CINAHL 数据库中关于住宅老年护理 CoPs 的研究。提取 CoPs 的三个关键特征（Wenger 等人描述的“领域”、“社区”和“实践”）的数据。使用 Kirkpatrick 的四级评估（成员的反应、学习、行为和结果）来检查 CoPs 效果的研究。采用混合方法评估工具进行质量评估。
19 篇文章报道了 13 个住宅老年护理 CoPs。大多数 CoPs 的目标是提高护理质量（n=9，69%），而其他 CoPs 的目标是教育成员（n=3，23%）。成员通常是多学科的（n=8，62%），互动方式是面对面（n=6，46%）、在线（n=3，23%）或两者兼有（n=4，31%）。一些 CoPs 在规划小组的帮助下（n=4，31%）或作为更大合作的一部分（n=4，31%）开发，并通过促进者（n=7，54%）或根据成员反馈进行调整（n=2，15%）来维持。13 项（81%）研究评估了成员的反应，3 项（24%）研究评估了成员的行为。研究的异质性和报告水平使得难以综合研究结果。
本审查揭示了 CoPs 在住宅老年护理中的使用原因和方式的差异，这与之前医疗保健中 CoPs 的审查结果一致。虽然这些发现可以为该背景下 CoPs 的发展提供信息，但需要进一步研究来了解 CoPs（包括成员构成、交付模式、促进者类型和会议频率）如何影响护理质量。
