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#Post#: 257--------------------------------------------------
Care improvement in carehomes
By: Annabeli5 Date: May 14, 2015, 4:37 am
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Integration/partnership
Better integration of services for older people has long been
promoted as improving quality of care and potentially reducing
costs. Local circumstances, legal context, funding streams,
procedural and structural arrangements will all affect
integration, as will a collaborative culture. Multidisciplinary
reviews also show benefits. However, a more formal systems
approach to identifying organisational and environmental
characteristics associated with nursing homes which are more
successful has demonstrated limited value.
Quality improvement initiatives
Quality improvement interventions include monitoring quality of
care, strengthening the care-giving workforce and building
organisational capacity. Simply providing nursing homes with
comparative quality performance feedback, access to training,
and staff performance incentives does not appear to lead to
significant improvements. Additional real-time feedback of
adherence may produce improvements, although these are not
sustainable. Quality improvement is more likely to be successful
in homes with a culture that promotes innovation and staff
empowerment.
Evidence-based practice
The use of evidence-based clinical guidelines and administrative
policies/practices is not widespread. Discussion of the role of
nursing homes as a suitable alternative to hospital care for
older people has highlighted the need to advance the development
of evidence-based practice in UK care homes.
Geriatric nurse specialists
Introducing a geriatric nurse practitioner into a nursing home
is reported to lead to a reduction in hospital admissions,
improvements in pressure ulcers, incontinence, depression, and
aggressive behaviour, but little difference in residents’
functional status, physical condition, or satisfaction. A US
model involving case management of frail older people by nurse
practitioners (EverCare) has reduced mortality and preventable
hospitalisations. Transfer of the EverCare model to the UK has
produced less favourable effects.
In-reach, support teams and telecare
A few studies describe the establishment of nursing inreach
teams to improve clinical care in care homes. Only one
evaluation has considered cost-effectiveness. Having an older
people’s specialist nurse in a multidisciplinary team is
reported to have benefits, especially in managing the interface
between nursing homes and primary care. The potential for
telecare has been extensively discussed. This may make better
use of professionals’ time, but the potential for remote patient
monitoring in residential care homes has only been considered
recently and systems will need careful assessment.
Resident-oriented care
Resident-oriented care focuses on quality of life. Factors
considered include resident activities, social contacts and
staff knowledge and evaluation of individuals. This approach can
reduce care gaps, particularly in psychosocial aspects of care.
It can also have a positive impact on staff e.g. lower frequency
of sick leave. It appears to have a limited effect on job
characteristics, however, with task-oriented care remaining and
delegation to nursing care-givers difficult to achieve.
Management of change
Management and leadership style have an important impact on
quality improvement initiatives. Culture change may be required
to facilitate improvement, especially if staff, residents and
family members have different interpretations of care. Culture
change must begin with owners and managers building new
relationships with all stakeholders. New work practices may be
insufficient if adopted without investment in training or a
commitment to establish participatory decision-making.
#Post#: 260--------------------------------------------------
Re: Care improvement in carehomes
By: admini5 Date: May 14, 2015, 4:44 am
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Reference to the study.. :)
#Post#: 263--------------------------------------------------
Re: Care improvement in carehomes
By: Annabeli5 Date: May 14, 2015, 4:48 am
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Reference:
HTML http://www.jrf.org.uk/sites/files/jrf/2326.pdf
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