Implementation of a Complex Intervention to Support Leadership Development in Nursing Homes: A Multimethod Participatory Study

Dewar, Belinda; Barrie, Karen; Sharp, Cathy; Meyer, Julienne

doi:10.1177/0733464817705957

“…Our study also identifies that managers who possess poor knowledge about aged care and related staff issues do not provide effective leadership that helps reduce staff turnover (Fallatah et al 2017). Education and training for managers have been demonstrated to improve self-awareness of their role and responsibilities, including leading by example and developing positive engagement and relationships with staff (Dewar et al 2019).…”

Section: Discussionmentioning

confidence: 88%

Care workers’ perspectives of factors affecting a sustainable aged care workforce

Xiao

¹

,

Harrington

²

,

Mavromaras

³

et al. 2020

International Nursing Review

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Aims: To identify the reasons why workers decide to enter, stay or leave the aged care workforce; and the factors influencing them to transition between community and residential sectors in Australia. Background: Factors affecting the recruitment and retention of suitable care workers in aged care are complex and influenced by personal, institutional and societal factors. Methods: A qualitative description study design. Results: In total, 32 staff participated in the study. Five main themes were identified: entering aged care with a passion for the job; entering aged care as it is the only employment option; factors attracting care workers to stay in aged care; factors influencing care workers to leave the job; and preferring to work in residential aged care rather than community aged care. Conclusion:Issues relating to the attraction and retention of aged care workers are influenced by personal, institutional and societal factors. Critical shortages in the aged care workforce make the industry more susceptible to crises such as COVID-19 outbreaks. Implication for nursing practice: Aged care organizations need to create a positive psychosocial work environment for staff to improve the attraction and retention of skilled care workers. They also need to develop staff recruitment guidelines to ensure care workers with the appropriate skills and training and a passion for working with older adults are selected. Staff development programmes need to focus on learning activities that enable staff to build peers support in the work environment. Implications for health policy: There is a need to mandate curriculum to enable nursing students to receive more gerontological education and exposure to aged care throughout their education. Aged care quality standards need to mandate transition support for new graduate nurses.

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“…In a prior series of studies [47,48], we incorporated the evidence-based practices of strengths-based learning [49,50], systematic observation [51], efficiency [48,52], and relationship-based teamwork [53,54] into a specific frontline staff huddling program known as the LOCK program. The LOCK program enables staff to (1) Learn from bright spots (focus on positive evidence of strengths); (2) Observe (collect data through systematic observation); (3) Collaborate in huddles (conduct frontline staff huddles); and (4) Keep it bite-size (limit activities to 5-15 min for efficiency) [48,55].…”

Section: Huddling and The Lock Programmentioning

confidence: 99%

Enhancing sleep quality for nursing home residents with dementia: a pragmatic randomized controlled trial of an evidence-based frontline huddling program

Snow

¹

,

Loup

²

,

Morgan

³

et al. 2021

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Background Disturbed sleep places older adults at higher risk for frailty, morbidity, and even mortality. Yet, nursing home routines frequently disturb residents’ sleep through use of noise, light, or efforts to reduce incontinence. Nursing home residents with Alzheimer’s disease and or related dementias—almost two-thirds of long-stay nursing home residents—are likely to be particularly affected by sleep disturbance. Addressing these issues, this study protocol implements an evidence-based intervention to improve sleep: a nursing home frontline staff huddling program known as LOCK. The LOCK program is derived from evidence supporting strengths-based learning, systematic observation, relationship-based teamwork, and efficiency. Methods This study protocol outlines a NIH Stage III, real-world hybrid efficacy-effectiveness pragmatic trial of the LOCK sleep intervention. Over two phases, in a total of 27 non-VA nursing homes from 3 corporations, the study will (1) refine the LOCK program to focus on sleep for residents with dementia, (2) test the impact of the LOCK sleep intervention for nursing home residents with dementia, and (3) evaluate the intervention’s sustainability. Phase 1 (1 year; n = 3 nursing homes; 1 per corporation) will refine the intervention and train-the-trainer protocol and pilot-tests all study methods. Phase 2 (4 years; n = 24 nursing homes; 8 per corporation) will use the refined intervention to conduct a wedge-design randomized, controlled, clinical trial. Phase 2 results will measure the LOCK sleep intervention’s impact on sleep (primary outcome) and on psychotropic medication use, pain and analgesic medication use, and activities of daily living decline (secondary outcomes). Findings will point to inter-facility variation in the program’s implementation and sustainability. Discussion This is the first study to our knowledge that applies a dementia sleep intervention to systematically address known barriers to nursing home quality improvement efforts. This innovative study has future potential to address clinical issues beyond sleep (safety, infection control) and expand to other settings (assisted living, inpatient mental health). The study’s strong team, careful consideration of design challenges, and resulting rigorous, pragmatic approach will ensure success of this promising intervention for nursing home residents with dementia. Trial registration NCT04533815, ClinicalTrials.gov, August 20, 2020.

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“…In a prior series of studies (48,49), we incorporated the evidence-based practices of strengths-based learning (50,51), systematic observation (52), e ciency (49,53), and relationship-based teamwork (54,55) into a speci c frontline staff huddling program known as the LOCK program. The LOCK program enables staff to (1) Learn from bright spots (focus on positive evidence of strengths); (2) Observe(collect data through systematic observation); (3) Collaborate in huddles (conduct frontline staff huddles); and (4) Keep it bite-size (limit activities to 5-15 minutes for e ciency) (49,56).…”

Section: Huddling and The Lock Programmentioning

confidence: 99%

Enhancing Sleep Quality for Nursing Home Residents with Dementia: A Pragmatic Randomized Controlled Trial of an Evidence-Based Frontline Huddling Program

Snow

¹

,

Loup

²

,

Morgan

³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

Background Disturbed sleep places older adults at higher risk for frailty, morbidity, and even mortality. Yet, nursing home routines frequently disturb residents’ sleep through use of noise, light, or efforts to reduce incontinence. Nursing home residents with Alzheimer’s disease and or related dementias—almost two-thirds of long-stay nursing home residents—are likely to be particularly affected by sleep disturbance. Addressing these issues, this study protocol implements an evidence-based intervention to improve sleep: a nursing home frontline staff huddling program known as LOCK. The LOCK program is derived from evidence supporting strengths-based learning, systematic observation, relationship-based teamwork, and efficiency. Methods This study protocol outlines a NIH Stage III, real-world hybrid efficacy-effectiveness pragmatic trial of the LOCK sleep intervention. Over two phases, in a total of 27 non-VA nursing homes from 3 corporations, the study will (1) refine the LOCK program to focus on sleep for residents with dementia, (2) test the impact of the LOCK sleep intervention for nursing home residents with dementia, and (3) evaluate the intervention’s sustainability. Phase 1 (1 year; n = 3 nursing homes; 1 per corporation) will refine the intervention and train-the-trainer protocol and pilot-tests all study methods. Phase 2 (4 years; n = 24 nursing homes; 8 per corporation) will use the refined intervention to conduct a wedge-design randomized, controlled, clinical trial. Phase 2 results will measure the LOCK sleep intervention’s impact on sleep (primary outcome) and on psychotropic medication use, pain and analgesic medication use, and activities of daily living decline (secondary outcomes). Findings will point to inter-facility variation in the program’s implementation and sustainability. Discussion This is the first study to our knowledge that applies a dementia sleep intervention to systematically address known barriers to nursing home quality improvement efforts. This innovative study has future potential to address clinical issues beyond sleep (safety, infection control) and expand to other settings (assisted living, inpatient mental health). The study’s strong team, careful consideration of design challenges, and resulting rigorous, pragmatic approach will ensure success of this promising intervention for nursing home residents with dementia. Trial registration: NCT04533815, ClinicalTrials.gov, August 20, 2020.

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Implementation of a Complex Intervention to Support Leadership Development in Nursing Homes: A Multimethod Participatory Study

Abstract: This is the accepted version of the paper.This version of the publication may differ from the final published version. Permanent repository link

Cited by 20 publications

References 41 publications

Care workers’ perspectives of factors affecting a sustainable aged care workforce

Care workers’ perspectives of factors affecting a sustainable aged care workforce

Enhancing sleep quality for nursing home residents with dementia: a pragmatic randomized controlled trial of an evidence-based frontline huddling program

Enhancing Sleep Quality for Nursing Home Residents with Dementia: A Pragmatic Randomized Controlled Trial of an Evidence-Based Frontline Huddling Program

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