Patient safety in the nursing home: how nursing staff assess and communicate about change in condition

Nursing homes must improve quality of care even as it becomes increasingly complex, and patient safety science may provide a helpful paradigm. Training materials are needed to build staff capacity for clinical assessment and communication, thereby improving care processes. Designed to develop curricular materials, this study used focus groups to determine how experienced nurses and aides assess and communicate about resident clinical changes. Four focus groups were conducted, and interviews were analyzed for themes in an iterative process by multidisciplinary team members. Staff reported that consistent caregiving enables detection of subtle clinical changes; aides further noted the importance of affective bonding. Aides and nurses alike regarded all clinical changes as potentially significant, while nursing staff lacked a consistent approach to assessment. Using a patient safety framework, structural changes and process elements were identified as important topics for further training to support clinical communication and improve resident and facility outcomes.