Open Access Open Access  Restricted Access Subscription Access

Report of a pilot study of quality improvement in nursing homes led by healthcare aides

Peter Norton, Lisa Cranley, Greta Cummings, Carole Estabrooks

Abstract


Objective: Healthcare aides (unregulated care providers), who deliver the majority of direct care in Canadian nursing homes, have high levels of emotional exhaustion and cynicism. However, they also have remarkably high levels of job efficacy. Strategies to empower this workforce may reduce cynicism and draw on their high levels of job efficacy. The primary objective of this study was to act as proof-of-principle to determine whether quality improvement teams led by healthcare aides could be established in nursing homes and function on a daily basis.

Methods: This study was a pilot test of a complex intervention using a mixed methods approach. We used a combination of education, networking and coaching to engage staff teams in quality improvement in 1 of 3 areas (pain control, skin care or behaviour management). We measured healthcare aides’ quality of work life, informal communication and research (best practice) use before and after the intervention. To understand the effect of quality of care at the bedside we used risk-adjusted quality indicators derived from Resident Assessment Instrument - Minimum Data Set 2.0 data.

Results: A total of 10 teams participated in the intervention. At least 70% of the teams succeeded in learning and applying the improvement model and methods for local measurement. For 50% of the teams, data showed measurable improvement in the clinical areas. There were no significant differences between pre and post measures of survey variables.

Conclusions: We have demonstrated the ability of healthcare aides to engage in quality improvement initiatives at the bedside in a collaborative environment and advance our results as an important contribution to person-centered healthcare.


Full Text:

PDF

References


Estabrooks, C., Hutchinson, A., Squires, J., Birdsell, J., Cummings, G., Degner, L., Morgan, D. & Norton, P. (2009). Translating Research in Elder Care: An introduction to a study protocol series. Implementation Science 4, 51.

Estabrooks, C.A., Squires, J.E., Cummings, G.G., Teare, G.F. & Norton, P.G. (2009 ). Study protocol for the translating research in elder care (TREC): building context – an organizational monitoring program in long-term care project (project one). Implementation Science 4, 52.

Rycroft-Malone, J., Dopson, S., Degner, L., Hutchinson, A.M., Morgan, D., Stewart, N. & Estabrooks, C.A. (2009). Study protocol for the Translating Research in Elder Care (TREC): Building context through case studies in long-term care project (project two). Implementation Science 4, 53.

Beckstead, J.W. (2002). Confirmatory factor analysis of the Maslach Burnout Inventory among Florida nurses. International Journal of Nursing Studies 39 (8) 785-792.

Poghosyan, L., Aiken, L.H. & Sloane, D.M. (2009). Factor structure of the Maslach burnout inventory: An analysis of data from large scale cross-sectional surveys of nurses from eight countries. International Journal of Nursing Studies 46 (7) 894-902.

Fawcett, J. (1982). Utilization of nursing research findings. Image: The Journal of Nursing Scholarship 14 (2) 57-62.

McCannon, C.J., Schall, M.W., Calkins, D.R. & Nazem, A.G. (2006). Saving 100 000 lives in US hospitals. British Medical Journal 332 (7553) 1328-1330.

Institute for Healthcare Improvement. (2003). The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. In: IHI Innovation Series White Paper, Cambridge, MA: Institute for Healthcare Improvement.

Cranley, L., Norton, P., Cummings, G., Barnard, D. & Estabrooks, C. (2011). SCOPE: Safer care for older persons (in residential) environments: A study protocol. Implementation Science 6, 71.

Puxty, J., Brander, R.A., Murphy, S. & Byrnes, V. (2012). Promoting quality improvement in long-term care. A multi-site collaboration to improve outcomes with pneumonia, falls, bacteriuria, and behavioural issues in dementia. Healthcare Quarterly 15 (2) 70-74.

Boockvar, K., Brodie, H.D. & Lachs, M. (2000). Nursing assistants detect behaviour changes in nursing home residents that precede acute illness: Development and validation of an illness warning instrument. Journal of the American Geriatrics Society 48 (9) 1086-1091.

Kontos, P.C., Miller, K.L., Mitchell, G.J. & Cott, C.A. (2010). Dementia care at the intersection of regulation and reflexivity: a critical realist perspective. Journal of Gerontology: Social Sciences 66B (1) 119-128.

Chappell, N.L. & Novak, M. (1994). Caring for institutionalized elders: Stress among nursing assistants. The Journal of Applied Gerontology 13 (3) 299-315.

Goodridge, D., Johnston, P. & Thomson, M. (1996). Conflict and aggression as stressors in the work environment of nursing assistants: Implications for institutional elder abuse. Journal of Elder Abuse & Neglect 8 (1) 49-67.

Yeatts, D.E., Cready, C., Swan, J. & Shen, Y. (2010). The perception of training availability among certified nurse aides: Relationship to CNA performance, turnover, attitudes, burnout and empowerment. Gerontology & Geriatrics Education 31, 115-132.

Barry, T., Brannon, D. & Mor, V. (2005). Nurse aide empowerment strategies and staff stability: Effects on nursing home resident outcomes. Gerontologist 45 (3) 309-317.

Yeatts, D.E. & Cready, C.M. (2007). Consequences of empowered CNA teams in nursing home settings: A longitudinal assessment. Gerontologist 47, 323-339.

Cready, C.M., Yeatts, D.E., Gosdin, M.M. & Potts, H.F. (2008). CNA empowerment: Effects on job performance and work attitudes. Journal of Gerontological Nursing 34 (3) 26-34.

Brabant, L.H., Lavoie-Tremblay, M., Viens, C. & Lefrançois, L. (2007). Engaging health care workers in improving their work environment. Journal of Nursing Management 15, 313-320.

Castle, N.G. & Engberg, J. (2007). The Influence of Staffing Characteristics on Quality of Care in Nursing Homes. Health Services Research 42 (5) 1822-1847.

Gibbons, J.M. (2006). Employee engagement: A review of current research and its implications. In: Conference Board of Canada.

Scott-Cawiezell, J., Schenkman, M., Moore, L., Vojir, C., Connolly, R.P., Pratt, M. & Palmer, L. (2004). Exploring Nursing Home Staff's Perceptions of Communication and Leadership to Facilitate Quality Improvement. Journal of Nursing Care Quality 19 (3) 242-252.

Grimshaw, J.M., Thomas, R.E., MacIennan, G., Fraser, C., Ramsey, C.R., Vale, L., Whitty, P., Eccles, M.P., Matowe, L., Shirran, L., Wensing, M., Dijkstra, R. & Donaldson, C. (2004). Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 8 (6) 1-72.

Janes, N., Sidani, S., Cott, C. & Rappolt, S. (2008). Figuring it Out in the Moment: A Theory of Unregulated Care Providers' Knowledge Utilization in Dementia Care Settings. Worldviews on Evidence-Based Nursing 5 (1) 13-24.

Cranley, L.A., Norton, P.G., Cummings, G.G., Barnard, D., Batra-Garga, N. & Estabrooks, C.A. (2012). Identifying resident care areas for a quality improvement intervention in long-term care: A collaborative approach. BMC Geriatrics In review.

Dogherty, E.J., Harrison, M.B. & Graham, I.D. (2010). Facilitation as a Role and Process in Achieving Evidence-Based Practice in Nursing: A Focused Review of Concept and Meaning. Worldviews on Evidence-Based Nursing 7 (2) 76-89.

McCormack, B., Kitson, A., Harvey, G., Rycroft-Malone, J., Titchen, A. & Seers, K. (2002). Getting evidence into practice: The meaning of 'context'. Journal of Advanced Nursing 38 (1) 94-104.

Seers, K., Cox, K., Crichton, N., Edwards, R.T., Eldh, A.C., Estabrooks, C.A., Harvey, G., Hawkes, C., Kitson, A., Linck, P., McCarthy, G., McCormack, B., Mockford, C., Rycroft-Malone, J., Titchen, A. & Wallin, L. (2012). FIRE (Facilitating Implementation of Research Evidence): A study protocol. Implementation Science 7, 25.

Estabrooks, C., Morgan, D., Squires, J., Boström, A-M., Slaughter, S., Cummings, G. & Norton, P. (2011). The care unit in nursing home research: Evidence in support of a definition. BMC Medical Research Methodology 11, 46.

Estabrooks, C., Squires, J., Hayduk, L., Cummings, G. & Norton, P. (2011). Advancing the Argument for Validity of the Alberta Context Tool with Healthcare Aides in Residential Long-Term Care. BMC Medical Research Methodology 11, 107.

Estabrooks, C.A., Squires, J.E., Cummings, G.G., Birdsell, J.M. & Norton, P.G. (2009). Development and assessment of the Alberta Context Tool. BMC health services research 9, 234.

Estabrooks, C.A., Squires, J.E., Hutchinson, A.M., Scott, S., Cummings, G.G., Kang, S.H., Midodzi, W.K. & Stevens, B. (2011). Assessment of variation in the Alberta Context Tool: The contribution of unit level contextual factors and specialty in Canadian pediatric acute care settings. BMC health services research 11, 251.

Maslach, C., Jackson, S.E. & Leiter, M.P. (1996). Maslach Burnout Inventory: Manual. Palo Alto, CA: Consulting Psychologists Press.

QualityMetric Incorporated. (1999). SF-8™ Health Survey.

Squires, J., Estabrooks, C.A., Newburn-Cook, C. & Gierl, M. (2011). Validation of the Conceptual Research Utilization Scale: An Application of the Standards for Educational and Psychological Testing in Healthcare. BMC health services research, 11, 107.

Jones, R., Hirdes, J., Poss, J., Kelly, M., Berg, K., Fries, B. & Morris, J. (2010). Adjustment of nursing home quality indicators. BMC health services research 10, 96.

Miles, M.B. & Huberman, A.M. (1994). Qualitative Data Analysis: An Expanded Sourcebook. Thousand Oaks: Sage.

Kang, S.H., Squries, J. & Estabrooks, C.A. (2012). Simulation results about sample size issue on aggregation statistics: Comparing the results between TROPIC (nurse, urban, acute care) and TREC (healthcare aide, urban, LTC) data. In: KUSP Report, Edmonton, AB: Knowledge Utilization Studies Program, University of Alberta.

Montgomery, D.C. (1996). Introduction to Statistical Quality Control. New York: John Wiley and Sons.

Thor, J., Lundberg, J., Ask, J., Olsson, J., Carli, C., Härenstam, K.P. & Brommels, M. (2007). Application of statistical process control in healthcare improvement: systematic review. Quality and Safety in Health Care 16 (5) 387-399.

Abel, R.L., Warren, K., Bean, G., Gabbard, B., Lyder, C.H., Bing, M. & McCauley, C. (2005). Quality Improvement in Nursing Homes in Texas: Results From a Pressure Ulcer Prevention Project. Journal of the American Medical Directors Association 6 (3) 181-188.

Buhr, G.T. & White, H.K. (2006). Quality Improvement Initiative for Chronic Pain Assessment and Management in the Nursing Home: A Pilot Study. Journal of the American Medical Directors Association 7 (4) 246-253.

Morley, J.E. (2008). Rapid Cycles (Continuous Quality Improvement), an Essential Part of the Medical Director's Role. Journal of the American Medical Directors Association 9 (8) 535-538.

Ouslander, J.G. (2007). Quality Improvement Initiatives for Urinary Incontinence in Nursing Homes. Journal of the American Medical Directors Association 8 (Supplement 3) S6-S11.

Ouslander, J.G., Patry, G. & Besdine, R.W. (2007). Quality Improvement in Nursing Homes: A Call to Action. Journal of the American Medical Directors Association 8 (3) 138-141.

Sales, A.E., Bostrom, A-M., Bucknall, T., Draper, K., Fraser, K., Schalm, C. & Warren, S. (2012). The Use of Data for Process and Quality Improvement in Long Term Care and Home Care: A Systematic Review of the Literature. Journal of the American Medical Directors Association 13 (2) 103-113.

Simmons, S.F. (2007). Quality Improvement for Feeding Assistance Care in Nursing Homes. Journal of the American Medical Directors Association 8 (Supplement 3) S12-S17.

Gortner, S. & Schultz, P.R. (1988). Approaches to nursing science methods. Image: Journal of Nursing Scholarship 20 (1) 22-24.

Bradley, E., Curry, L., Ramanadhan, S., Rowe, L., Nembhard, I. & Krumholz, H. (2009). Research in action: using positive deviance to improve quality of health care. Implementation Science 4, 25.




DOI: http://dx.doi.org/10.5750/ejpch.v1i1.658

Refbacks

  • There are currently no refbacks.