Practice Change Interventions in Long-Term Care Facilities: What Works, and Why?

Abstract

RÉSUMÉAu cours des trois dernières décennies, il y a eu une augmentation notable dans les études de pratique concernant changements dans les interventions en soins de longue durée (SLD). Cette critique, basé sur une approche réaliste modifi ée, répond aux questions suivantes: Quelles caractéristiques de changement d'intervention fonctionnent bien? Et, dans quelles circonstances, fonctionnent-elles, et pourquoi? Une approche réaliste modifi ée a été appliquée pour identifi er et expliquer les interactions parmi le contexte, le mécanisme, et les résultats. Nous avons cherché des bases de données électroniques et la littérature publiée pour les études empiriques des interventions pratiques modifi ées qui (a) ont été menées dans les établissements de SLD, (b) ont impliqué le personnel soignant formel, et (c) ont fait état d'une évaluation formelle. Quatre-vingt-quatre articles répondaient à nos critères d'inclusion. Les interventions qui ne comprenaient que des facteurs prédisposants étaient moins susceptibles d'être effi caces, tandis que les interventions qui comprenaient des facteurs renforçants étaient les plus susceptibles de produire des résultats durables. Nous avons conclu que les interventions visant à changer les pratiques dans les milieux de SLD devraient inclure les facteurs habilitants et renforçants qui sont à la fois réalisables et effi caces. ABSTRACTOver the past three decades, there has been a notable increase in studies of practice change interventions in longterm care (LTC) settings. This review, based on a modifi ed realist approach, addresses the following questions: What practice change intervention characteristics work? And, in what circumstances do they work and why? A modifi ed realist approach was applied to identify and explain the interactions among context, mechanism, and outcome. We searched electronic databases and published literature for empirical studies of practice change interventions that (a) were conducted in LTC settings, (b) involved formal care staff members, and (c) reported a formal evaluation. Ninety-four articles met the inclusion criteria. Interventions that included only predisposing factors were least likely to be effective. Interventions that included reinforcing factors were most likely to produce sustained outcomes. We concluded that interventions aimed at practice change in LTC settings should include feasible and effective enabling and reinforcing factors.

Process Evaluation of a Participatory, Multimodal Intervention to Improve Evidence‐Based Care in Long‐Term Care Settings

“…() would characterize as more mature and Caspar et al. () would describe as enabling or reinforcing. These strategies included setting up reward systems, role modeling, modifying communication patterns, and structured problem‐solving.…”

“…This precipitated two change mechanisms: managerial support and a disruptive innovation. Others have identified managerial support for innovations in LTC (Caspar et al., ; Colón‐Emeric et al., ) as critical enabling and reinforcing factors for both implementing and sustaining change. However, the interdepartmental (horizontal) mix of players has received less attention.…”

“…Educational interventions alone, aimed at either residents or staff, are often reported to be insufficient to improve outcomes (Caspar, Cooke, Phinney, & Ratner, ). In part, disappointing results have been attributed to educational programs that failed to directly involve unregulated workers who provide the majority of residents’ care (Colón‐Emeric et al., ; Estabrooks, Squires, Carleton, Cummings, & Norton, ).…”

“…Enabling and reinforcing factors have been identified as critical for successful interventions in LTC (Caspar et al., ). The Resident Assessment Instrument—Minimum Data Set (RAI‐MDS) can provide such reinforcement.…”

Optimising mobility through the sit‐to‐stand activity for older people living in residential care facilities: A qualitative interview study of healthcare aide experiences

“…Implementing evidence‐based practice in nursing homes can be challenging. HCAs are usually excluded from discussions about resident care (Caspar, Cooke, Phinney, & Ratner, ), and their daily work is often task‐oriented with an emphasis on completing tasks quickly (Knopp‐Sihota et al., ). Despite these obstacles, data from one research group indicate that the HCAs were able to perform an average of two sit‐to‐stand sessions per day with the residents, which has been shown to be sufficient to maintain, and in some cases modestly improve, residents’ mobility (Slaughter & Estabrooks, ; Slaughter et al, ).…”