Direct Assessment of Quality of Care in a Geriatric Nursing Home

Abstract

Direct observation was used to examine multiple aspects of care provided in a proprietary nursing home. The samples were taken at random intervals, 7 days per week for 5 weeks, across several categories of environmental and resident conditions as well as staff and resident activity. Results showed a high degee of compliance with predefined standards (based on current federal regulations) for environmental and resident conditions. Overall distributions of resident and staff activity showed results similar to those found in previous studies, with residents spending most of their time engaged in nonsocial activity and staff spending the majority of their time engaged in nonresident work. When data were analyzed across areas of the facility, times of day, and weekdays versus weekends, some differences were noted. Weekend versus weekday comparisons showed higher resident:staff ratios on weekends and more resident inactivity, but no significant differences in environmental or resident conditions. In addition, more frequent resident care, resident interaction, and resident activity were observed in Medicare units than in non-Medicare units. Results are discussed in terms of federal requirements for monitoring the quality of care in nursing homes and the potential use of time sampling expressly for this purpose.

Effects of Reactivity to Observations on Staff Performance

“…Reactivity, which refers to the influence that an observation procedure exerts on behavior (Kazdin, 1979), is a problematic and continuing concern in research on staff performance (Ivancic & Helsel, 1998). A number of authors have acknowledged possible limitations in studies on staff behavior due to the potential reactivity of observations (Fleming & Sulzer-Azaroff, 1992;Shore, Lerman, Smith, Iwata, & DeLeon, 1995).…”

“…Despite concerns over reactivity, as well as experimental evidence indicating that it can be an obstacle when evaluating staff behavior (Reid, Parsons, Green, & Schepis, 1991), little attention has been directed to reactivity as a dependent variable. Although some studies have attempted to include controls for reactivity (Fleming & Sulzer-Azaroff, 1992;Parsons, Rollyson, & Reid, 2004;Shore et al, 1995), the extent to which such procedures actually affect staff reactivity has not been examined experimentally in typical staff training and management research. The purpose of this study was to document and then decrease reactivity during observations of staff performance following completion of a staff-training program.…”

Improving implementation of evidence-based practice in mental health service delivery: protocol for a cluster randomised quasi-experimental investigation of staff-focused values interventions

“…In particular, the role of values as a means to promoting uptake and a construct to be measured within the science of implementation requires elaboration. A range of models and measures exist to explain and capture uptake of new practices, ranging from attitudinal [62] to supervisor-rated [63], objective measures of observed performance on the job [64], and composite measures that combine multiple elements [65]. While the latter of these allow a snapshot of whether a desired practice is being carried out within the workplace, they do not allow us to make any assertions about ‘how’ the work is being done.…”

Applied Behavior Analysis: Understanding and Changing Behavior in the Community—A Representative Review

“…The quality of geriatric care was investigated in a study that used random and systematic behavioral observations to determine the degree to which staff in a nursing home adhered to regulations and to assess the activities of residents (i.e., social, active, and inactive behavior) and staff (i.e., resident-focused versus nonresident activities) (Shore, Lerman, Smith, Iwata, & DeLeon, 1995). Observations showed that the majority of the time residents were engaged in non-social activities while staff engaged in high rates of nonresident work.…”