Sustaining a best-care practice in a nursing home.

This study tested whether an action research organizational intervention fostering participatory management practices would sustain a nursing best-care practice protocol in a nursing home. An experimental nursing home (EH) and a control nursing home (CH) with similar characteristics were studied over a 4-year period. A pretest/posttest quasi-experimental design was used. Baseline data were co[lected on residents, families, and the staffs at the EH and the CH. Staff turnover rates, demographics of participant groups, and surveys concerning job stress, nursing care, family involvement, and satisfaction of residents and family members served as proximal outcomes to indicate whether organizational changes had occurred in the EH. Sustaining best practices in a nursing home requires not only significant organizational change but also changes in regulatory support for quality care, sufficient staff resources to implement and monitor the practices, and a change coordinator with sufficient formal or informal influence.