Camilla B Pimentel1,2,3, Whitney L Mills4,5, Andrea Lynn Snow6,7,8, Jennifer A Palmer9, Jennifer L Sullivan9,10, Nancy J Wewiorski1, Christine W Hartmann1,11. 1. Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts. 2. New England Geriatric Research Education and Clinical Center, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts. 3. Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts. 4. Center for Innovation in Long-Term Services and Supports, Providence VA Medical Center, Rhode Island. 5. Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island. 6. Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, Alabama. 7. Alabama Research Institute on Aging and Department of Psychology, University of Alabama, Tuscaloosa, Alabama. 8. Department of Psychology, University of Alabama, Tuscaloosa. 9. Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Massachusetts. 10. Department of Health Law, Policy and Management, School of Public Health, Boston University, Massachusetts. 11. Department of Public Health, University of Massachusetts Lowell.
Abstract
BACKGROUND AND OBJECTIVES: Nursing homes pose unique challenges for implementation of research and quality improvement (QI). We previously demonstrated successful implementation of a nursing home-led intervention to improve relationships between frontline staff and residents in 6 U.S. Department of Veterans Affairs (VA) Community Living Centers (CLCs). This article discusses early adaptations made to the intervention and its implementation to enhance frontline staff participation. RESEARCH DESIGN AND METHODS: This is a formative evaluation of intervention implementation at the first 2 participating CLCs. Formative evidence-including site visitors' field notes, implementation facilitation records, and semistructured frontline staff interviews-were collected throughout the study period. Data analysis was informed by the Capability, Opportunity, Motivation, and Behavior model of behavior change. RESULTS: Adaptations were made to 5 a priori intervention implementation strategies: (a) training leaders, (b) training frontline staff, (c) adapting the intervention to meet local needs, (d) auditing and providing feedback, and (e) implementation facilitation. On the basis of a 6-month implementation period at the first CLC, we identified elements of the intervention and aspects of the implementation strategies that could be adapted to facilitate frontline staff participation at the second CLC. DISCUSSION AND IMPLICATIONS: Incremental implementation, paired with ongoing formative evaluation, proved critical to enhancing capability, opportunity, and motivation among frontline staff. In elucidating what was required to initiate and sustain the nursing home-led intervention, we provide a blueprint for responding to emergent challenges when performing research and QI in the nursing home setting. Published by Oxford University Press on behalf of The Gerontological Society of America 2020.
BACKGROUND AND OBJECTIVES: Nursing homes pose unique challenges for implementation of research and quality improvement (QI). We previously demonstrated successful implementation of a nursing home-led intervention to improve relationships between frontline staff and residents in 6 U.S. Department of Veterans Affairs (VA) Community Living Centers (CLCs). This article discusses early adaptations made to the intervention and its implementation to enhance frontline staff participation. RESEARCH DESIGN AND METHODS: This is a formative evaluation of intervention implementation at the first 2 participating CLCs. Formative evidence-including site visitors' field notes, implementation facilitation records, and semistructured frontline staff interviews-were collected throughout the study period. Data analysis was informed by the Capability, Opportunity, Motivation, and Behavior model of behavior change. RESULTS: Adaptations were made to 5 a priori intervention implementation strategies: (a) training leaders, (b) training frontline staff, (c) adapting the intervention to meet local needs, (d) auditing and providing feedback, and (e) implementation facilitation. On the basis of a 6-month implementation period at the first CLC, we identified elements of the intervention and aspects of the implementation strategies that could be adapted to facilitate frontline staff participation at the second CLC. DISCUSSION AND IMPLICATIONS: Incremental implementation, paired with ongoing formative evaluation, proved critical to enhancing capability, opportunity, and motivation among frontline staff. In elucidating what was required to initiate and sustain the nursing home-led intervention, we provide a blueprint for responding to emergent challenges when performing research and QI in the nursing home setting. Published by Oxford University Press on behalf of The Gerontological Society of America 2020.
Entities:
Keywords:
Long-term care; Methodology; Organizational and institutional issues; Qualitative research methods; Veterans
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