Integration/partnership
Better integration of services for older people has long been promoted as improving quality of care and potentially reducing costs. Local circumstances, legal context, funding streams, procedural and structural arrangements will all affect integration, as will a collaborative culture. Multidisciplinary reviews also show benefits. However, a more formal systems approach to identifying organisational and environmental characteristics associated with nursing homes which are more successful has demonstrated limited value.
Quality improvement initiatives
Quality improvement interventions include monitoring quality of care, strengthening the care-giving workforce and building organisational capacity. Simply providing nursing homes with comparative quality performance feedback, access to training, and staff performance incentives does not appear to lead to significant improvements. Additional real-time feedback of adherence may produce improvements, although these are not sustainable. Quality improvement is more likely to be successful in homes with a culture that promotes innovation and staff empowerment.
Evidence-based practice
The use of evidence-based clinical guidelines and administrative policies/practices is not widespread. Discussion of the role of nursing homes as a suitable alternative to hospital care for older people has highlighted the need to advance the development of evidence-based practice in UK care homes.
Geriatric nurse specialists
Introducing a geriatric nurse practitioner into a nursing home is reported to lead to a reduction in hospital admissions, improvements in pressure ulcers, incontinence, depression, and aggressive behaviour, but little difference in residents’ functional status, physical condition, or satisfaction. A US model involving case management of frail older people by nurse practitioners (EverCare) has reduced mortality and preventable hospitalisations. Transfer of the EverCare model to the UK has produced less favourable effects.
In-reach, support teams and telecare
A few studies describe the establishment of nursing inreach teams to improve clinical care in care homes. Only one evaluation has considered cost-effectiveness. Having an older people’s specialist nurse in a multidisciplinary team is reported to have benefits, especially in managing the interface between nursing homes and primary care. The potential for telecare has been extensively discussed. This may make better use of professionals’ time, but the potential for remote patient monitoring in residential care homes has only been considered recently and systems will need careful assessment.
Resident-oriented care
Resident-oriented care focuses on quality of life. Factors considered include resident activities, social contacts and staff knowledge and evaluation of individuals. This approach can reduce care gaps, particularly in psychosocial aspects of care. It can also have a positive impact on staff e.g. lower frequency of sick leave. It appears to have a limited effect on job characteristics, however, with task-oriented care remaining and delegation to nursing care-givers difficult to achieve.
Management of change
Management and leadership style have an important impact on quality improvement initiatives. Culture change may be required to facilitate improvement, especially if staff, residents and family members have different interpretations of care. Culture change must begin with owners and managers building new relationships with all stakeholders. New work practices may be insufficient if adopted without investment in training or a commitment to establish participatory decision-making.
Home
Forum
Search
Calendar
Arcade
Login
Register
