The Residential Aged Care Nurse-Led After-Hours Initiative, Enhancing nurse assessment and decision making.

Abstract

Background Current staffing levels and current care standards have been linked to negative clinical outcomes for Residents in living in Residential aged care. Low levels of confidence have impounded a Registered Nurses ability to meet many acute challenges found in this environment. The utilisation of Emergency Department transfers for acute ill residents is an increasing epidemic. This research project aimed to contemporise, adapt, implement and evaluate a set of Clinical Practice Guidelines (CPGs) and a Nurse Practitioner Role in Residential Aged Care adapted with permission from Waitemata District Health Board New Zealand [1, 2]. The purpose of the CPGs was to empower clinical staff in Residential Aged Care Facilities (RACFs), to recognise early clinical deterioration, provide safe evidence based care to residents, and prevent unnecessary transfers of residents to an acute hospital emergency departments.Methods Action research was chosen for this research because it was not only cyclic/participative in nature, but it provided a progressive evaluation of the CPGs implementation and the current context as it related to past, progressive, and post implementation nurse decision making practices. A total of 4 Focus groups with an average of eight respondents were recruited to this study (Total participants, 16 RNs and 16 PCWs).Results Focus group data showed unequivocal evidence of increased confidence among staff in implementing the care guidelines, communicating with fellow professionals, and assessing incidents. The CPGs and NP intervention was successful in engaging staff and developing their confidence with assessment of acute resident issues. Additional longitudinal research is required to better understand the influences of these interventions on ED presentations.Conclusions Research needs to better explore the direct correlation between PCW knowledge, skills, and training, and a failure to rescue residents experiencing an adverse event. This should also encompass more research scrutiny on the impact of poor communication practices between PCWs and the RN. The role NPs play in reducing ED utilisation needs greater long term evaluation to better ascertain clinical care and economic benefits.