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A model for implementing guidelines for person-centered care in a nursing home setting

Published online by Cambridge University Press:  19 August 2014

Sofia Vikström ,
Per-Olof Sandman ,
Ewa Stenwall ,
Anne-Marie Boström ,
Lotta Saarnio ,
Kristina Kindblom ,
David Edvardsson  and
Lena Borell
Sofia Vikström*
Affiliation:
Department of Neurobiology, Caring Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
Per-Olof Sandman
Affiliation:
The Medical Faculty, Division of Nursing, Umeå University, Umeå, Sweden Department of Neurobiology, Caring Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
Ewa Stenwall
Affiliation:
Department of Neurobiology, Caring Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
Anne-Marie Boström
Affiliation:
Department of Neurobiology, Caring Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden Department of Geriatric Medicine, Danderyd Hospital, Danderyd, Sweden
Lotta Saarnio
Affiliation:
Department of Neurobiology, Caring Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
Kristina Kindblom
Affiliation:
Department of Neurobiology, Caring Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden College of Physiotherapy, Pravara Institute of Medical Science, Loni, Rahata, Ahmednagar, Maharashtra, India
David Edvardsson
Affiliation:
The Medical Faculty, Division of Nursing, Umeå University, Umeå, Sweden School of Nursing and Midwifery, La Trobe University, Victoria, Australia
Lena Borell
Affiliation:
Department of Neurobiology, Caring Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
*
Correspondence should be addressed to: Sofia Vikström, Department of Neurobiology, Caring Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, 141 83 Huddinge, Sweden. Phone: +46-852483802; Email: [email protected].
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Abstract

Background:

Systematic evaluations of knowledge translation interventions in nursing homes to improve practice are scarce. There is also a lack of studies focusing on creating sustainable evidence-based practice in the setting of residential dementia care.

Methods:

The aim of this paper is to describe a model for implementing national evidence-based guidelines for care of persons with dementia in nursing homes. The secondary aim is to outline the nursing home staff experiences during the first year of the implementation process. The intervention had a participatory action research approach. This included educational activities such as: (i) thematic seminars introducing national guidelines for dementia care, (ii) regular unit-based seminars; and (iii) later dissemination of information in reflective seminars and several days of poster-exhibitions. Areas of practice development were selected on each of the 24 units, based on unit-specific needs, and a quality improvement strategy was applied and evaluated. Each unit met ten times during a period of eight months. Data for this study were extracted from the reflective seminars and poster presentations, analyzed using a qualitative content analysis.

Results:

Findings showed that implementation of guidelines were perceived by staff as beneficial for both staff and the residents. However, barriers to identification of relevant sources of evidence and barriers to sustainable implementation were experienced.

Conclusions:

One of our assumptions was that dementia nursing homes can benefit from becoming knowledge driven, with care practices founded in evidence-based sources. Our findings show that to be partly true, even though most staff units found their efforts to pursue and utilize knowledge adversely impacted by time-logistics and practical workload challenges.

Keywords

nursing homenational guidelinesdementiaparticipatory action research
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 1 , January 2015 , pp. 49 - 59
Copyright
Copyright © International Psychogeriatric Association 2014 

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References

Batalden, P., Davidoff, F., Marschall, M., Bibby, J. and Pink, C. (2011). So what? Now what? Exploring, understanding and using the epistemologies that inform the improvement of healthcare. BMJ QualSaf, 20, 99–105.Google ScholarPubMed
Boström, A. M., Slaughter, S. E., Chojecki, D. and Estabrooks, C. A. (2011). What do we know about knowledge translation in the care of older adults? A scoping review. Journal of the American Medical Directors Association, 13, 210–219.Google Scholar
Boström, A. M., Wallin, L. and Nordström, G. (2006). Research use in the care of older people: a survey among healthcare staff. International Journal of Older People Nursing, 1, 131–140.Google Scholar
Buckman, R. (2004). Building a Knowledge-Driven Organization, 1st edn. New York: McGraw-Hill.Google Scholar
Day, J., Higgins, I. and Koch, T. (2009). The process of practice redesign in delirium care for hospitalized older people: a participatory action research study. International Journal of Nursing Studies, 46, 13–22.Google Scholar
Edvardsson, D., Sandman, P. O. and Borell, L. (2014). Implementing national guidelines for person-centered care of people with dementia in residential aged care: effects on perceived person-centeredness, staff strain, and stress of conscience. International Psychogeriatrics, 26, 1171–1179.Google Scholar
Edvardsson, D., Winblad, B. and Sandman, P. O. (2008). Person-centered care of people with severe Alzheimer's disease: current status and ways forward. Lancet Neurology, 7, 362–367.Google Scholar
Elo, S. and Kyngäs, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62, 107–115.Google Scholar
Eriksson, L., Nga, N. T., Hoa, D. P., Persson, L.-Å., Ewald, U. and Wallin, L. (2011). Newborn care and knowledge translation – perceptions among primary healthcare staff in northern Vietnam. Implementation Science, 6, 29.CrossRefGoogle ScholarPubMed
Estabrooks, C. A. et al. (2009). Translating research in elder care: an introduction to a study protocol series. Implementation Science, 4, 51.Google Scholar
Fawcett, J. (2005). Contemporary Nursing Knowledge, 2nd edn. Philadelphia: F. A. Davis Company.Google Scholar
Forsner, T., Hansson, J., Brommels, M., Wistedt, A. A. and Forsell, Y. (2010). Implementing clinical guidelines in psychiatry; a qualitative study of perceived facilitators and barriers. BMC Psychiatry, 10, 8.Google Scholar
Freire, P. (1993). Pedagogy of the Oppressed. New York: Herder and Herder.Google Scholar
Garam, B., Cheek, J. and Alde, P. (2009). The research/practice nexus: underlying assumptions about the nature of research uptake into practice in literature pertaining to care of the older person. International Journal of Older People Nursing, 4, 219–226.CrossRefGoogle Scholar
Gerrish, K., Guillaume, L., Kirshbaum, M., McDonell, A., Tod, A. and Nolan, M. (2011). Factors influencing the contribution of advanced practice nurses to promoting evidence-based practice among front-line nurses: findings from a cross-sectional survey. Journal of Advanced Nursing, 67, 1079–1090.Google Scholar
Grant, J., Nelson, G. and Mitchell, T. (2008). Negotiating the challenges of participatory action research: Relationships, power, participation, change and credibility. In SAGE handbook on Action Research, 2nd edn. London: SAGE publications Ltd. Google Scholar
Grimshaw, J. et al. (2006). Towards evidence-based quality improvement. Journal of General Internal Medicine, 21, 14–20.Google Scholar
Grol, R. and Grimshaw, J. (2003). From best evidence to best practice: effective implementation of change in patients’ care. Lancet, 362, 1225–1230.Google Scholar
Humphrey, A. (2005). SWOT Analysis for Management Consulting. SRI Alumni Newsletter (SRI International). Available at: http://alumni.sri.com/newsletters/Dec-05.pdf. Accessed December 1, 2013.Google Scholar
Israel, B. A., Schulz, A. J., Parker, E. A., Becker, A. B., Allen, A. and Guzman, J. R. (2008). Critical issues in developing and following community-based participatory research principles. In Minkler, M. and Wallerstein, N. (eds.), Community-Based Participatory Research for Health (pp. 56–73). San Francisco, CA: Jossey-Bass.Google Scholar
Koch, T., Selim, P. and Kralik, D. (2002). Enhancing lives through the development of a community based participatory action research programme. Journal of Clinical Nursing, 11, 109–117.CrossRefGoogle ScholarPubMed
Lapaige, V. (2010). “Integrated knowledge translation” for globally oriented public health practitioners and scientists: framing together a sustainable transfrontier knowledge translation vision. Journal of Multidisciplinary Healthcare, 3, 33–47.CrossRefGoogle ScholarPubMed
McCormack, B. and McCance, T. V. (2006). The person-centred nursing conceptual framework. Journal of Clinical Nursing, 56, 1–8.Google Scholar
The National Board of Health and Welfare (2010). National Guidelines for Care of Persons with Dementia. Stockholm, Sweden: Socialstyrelsen. Available at: http://www.socialstyrelsen.se/nationalguidelines/nationalguidelinesforcareincasesofdementia. Accessed July 22, 2014.Google Scholar
Perry, L., Bellchambers, H., Howie, A., Moxey, A., Parkinson, L., Capra, S. and Byles, J. (2011). Examination of the utility of the promoting action on research implementation in health services framework for implementation of evidence based practice in residential aged care settings. Journal of Advanced Nursing, 67, 2139–2150.CrossRefGoogle ScholarPubMed
Rahman, A. N., Applebaum, R. A., Schnelle, J. F. and Simmons, S. F. (2012). Translating research into practice in nursing homes: can we close the gap? The Gerontologist, 52, 597–606.CrossRefGoogle ScholarPubMed
Reason, P. and Bradbury, H. (eds.) (2008). SAGE Handbook on Action Research, 2nd edn. London: SAGE Publications Ltd.Google Scholar
Rogers, E. M. (1995). Diffusion of Innovations, 4th edn. New York: Free Press.Google ScholarPubMed
Rycroft-Malone, J. (2008). Leadership and the use of evidence in practice. Worldviews on Evidence-Based Nursing, 5, 1–2.CrossRefGoogle ScholarPubMed
Sackett, D. L., Straus, S. E., Richardson, W. S., Rosenberg, W. and Haynes, R. B. (2000). Evidence-Based Medicine: How to Practice and Teach EBM, 2nd edn. Edinburgh: Churchill Livingstone.Google Scholar
Sciarra, E. (2012). The importance of practice guidelines in clinical care. Dimensions of Critical Care Nursing, 31, 84–85.CrossRefGoogle ScholarPubMed
Taylor, R. R., Braveman, B. and Hammel, J. (2004). Developing and evaluating community based services through participatory action research; two case examples. American Journal of Occupational Therapy, 58, 73–82.CrossRefGoogle ScholarPubMed
Thompson, D. S., Estabrooks, C. A., Scott-Findlay, S., Moore, K. and Wallin, R. (2007). Interventions aimed at increasing research use in nursing: a systematic review. Implementation Science, 2, 15. doi:10.1186/1748-5908-2-15 CrossRefGoogle ScholarPubMed
World Health Organization (2006). The World Health report 2006: Working together for Health, WHO. Available at: http://www.who.int/whr/2006/whr06_en.pdf. Accessed July 23, 2014.Google Scholar