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A controlled trial of an intervention to increase resident choice in long term care
John F Schnelle1, Annie Rahman, Daniel W Durkin
1Vanderbilt University, School of Medicine, Division of General Internal Medicine and Public Health, Center for Quality Aging, Nashville, TN, USA. John.Schnelle@Vanderbilt.edu
Objective:
The purpose of this study was to evaluate an intervention to improve staff offers of choice to nursing home residents during morning care.
Design:
A controlled trial with a delayed intervention design.
Setting:
Four community, for-profit nursing homes.
Participants:
A total of 169 long-stay nursing home residents who required staff assistance with morning care and were able to express their care preferences.
Intervention:
Research staff held weekly training sessions with nurse aides (NAs) for 12 consecutive weeks focused on how to offer choice during four targeted morning care areas: when to get out of bed, when to get dressed/what to wear, incontinence care (changing and/or toileting), and where to dine. Training sessions consisted of brief video vignettes illustrating staff-resident interactions followed by weekly feedback about how often choice was being provided based on standardized observations of care conducted weekly by research staff.
Measurements:
Research staff conducted standardized observations during a minimum of 4 consecutive morning hours per participant per week for 12 weeks of baseline and 12 weeks of intervention.
Results:
There was a significant increase in the frequency that choice was offered for 3 of the 4 targeted morning care areas from baseline to intervention: (1) out of bed, 21% to 33% (P < .001); dressing, 20% to 32% (P < .001); incontinence care, 18% to 23%, (P < .014). Dining location (8% to 13%) was not significant. There was also a significant increase in the amount of NA staff time to provide care from baseline to intervention (8.01 ± 9.0 to 9.68 ± 9.9 minutes per person, P < .001).
Conclusion:
A staff training intervention improved the frequency with which NAs offered choice during morning care but also required more time. Despite significant improvements, choice was still offered one-third or less of the time during morning care.
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