Nursing Empowerment: Promoting Evidence Based Practice Adoption in Long Term Care

Summary

Principal Investigator: JANET K P SPECHT
Affiliation: University of Iowa
Country: USA
Abstract: Poor quality nursing home (NH) care and resulting poor resident outcomes are of enormous and increasing concern, particularly for elders with urinary incontinence and pain. Despite the prevalence of these problems and available evidence-based practice protocols (EBP) that could dramatically improve care and outcomes, the dissemination and implementation of EBPs in nursing homes is sparse. Further, of the several EBP implementation studies, few are in NHs. Yet compared with acute care settings, several NH characteristics (lower staff educational levels, fewer professional RNs, and high staff turnover) suggest that successful EBP implementation strategies should be substantially different. Building on the research team's prior work and the Translation Science resource-rich environment of the U of I College of Nursing, this resubmission of a New Investigator R01 proposes a systematic trial of an innovative intervention (Multi-level Translation Research Application in Nursing Homes, M-TRAIN). M-TRAIN is a dual-pronged approach that combines models of Translation Research and Empowerment Research: The EBP component targets dissemination and implementation of practice changes; the staff empowerment component increases staff personal agency satisfaction to subsequently decrease turnover. The two mutually reinforcing approaches will result in better resident outcomes than either alone. Theoretically driven aims guide the directional hypotheses to test the effects of the M-TRAIN on 1) resident INCONTINENCE and PAIN outcomes 2) EBP adoption; 3) nursing home quality indicators (eg NHQI, state citations, staff turnover and 4) differentiate NH characteristics for high and low adopters. The M- TRAIN intervention includes short block education to teams from each NH, staff leadership training, and expert follow-up assistance with EBP implementation. A two-group pre/post test experimental design with repeated measures is used. Fifty NHs (stratified by size) will be randomly assigned to experimental or wait- listed control groups. Hierarchical linear modeling (HLM) approaches (levels 1-3) will be employed for analysis. The study is innovative because M-TRAIN addresses NH and staff variables that are barriers to practice changes, including training and supporting staff teams (RN & CNA) for EBP implementation and using an "insider" nurse consultant to assist the teams with implementation. The proposed research is significant because of the urgent need in NHs to improve outcomes for elderly residents with INCONTINENCE and PAIN, retain staff, and the potential the EBP Empowerment intervention has to do both. The study will evaluate outcomes for nursing homes, elderly residents, and new ways to assist RNs and CNAs use the most current knowledge to care for elders with pain and urinary incontinence.
Funding Period: 2007-07-25 - 2011-05-31
more information: NIH RePORT