Staff experiences with implementing a case conferencing care model in nursing homes: a focus group study

Nakrem, Sigrid, Stensvik, Geir-Tore, Skjong, Rickard Johan and Ostaszkiewicz, Joan 2019, Staff experiences with implementing a case conferencing care model in nursing homes: a focus group study, BMC health services research, vol. 19, pp. 1-11, doi: 10.1186/s12913-019-4034-0.

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Title Staff experiences with implementing a case conferencing care model in nursing homes: a focus group study
Author(s) Nakrem, Sigrid
Stensvik, Geir-Tore
Skjong, Rickard Johan
Ostaszkiewicz, JoanORCID iD for Ostaszkiewicz, Joan orcid.org/0000-0003-4159-4493
Journal name BMC health services research
Volume number 19
Article ID 191
Start page 1
End page 11
Total pages 11
Publisher BioMed Central
Place of publication London, Eng.
Publication date 2019
ISSN 1472-6963
Keyword(s) Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
Case conferencing
Dementia
Focus group
Geriatric assessment
Healthcare services
Implementation
Neuropsychiatric symptoms
Nursing homes
Organisation
Qualitative methods
Summary Background
A majority of nursing home residents have dementia, and many develop neuropsychiatric symptoms. These symptoms are often caused by neuropathological changes in the brain, but modifiable factors related to quality of care also have an impact. A team-based approach to care that include comprehensive geriatric assessments to facilitate clinical decision-making and structured case conference meetings could improve quality of care and quality of life for the residents. Despite recommendations to adopt this approach, dementia care does not reach standards of evidence-based practice. Better implementation strategies are needed to improve care. A cluster randomised controlled trial with a 12-month intervention was conducted, and the experiences of staff from the intervention nursing homes were explored in a qualitative study after the trial was completed. The aim of the present study was to describe: (i) staff’s experiences with the intervention consisting of comprehensive geriatric assessments of nursing home residents and case conferencing, and (ii) enablers and barriers to implementing and sustaining the intervention.

Methods
Four focus groups with a total of 19 healthcare staff were interviewed, representing four out of eight intervention nursing homes. Thematic content analysis was used to interpret the transcribed data.

Results
Two major themes emerged: 1) learning experiences and 2) enablers and barriers to implementation. The participants had experienced learning both on an organisational level: improvements in care and an organisation that could adjust and facilitate change; and on an individual level: becoming more conscious of residents’ needs and acquiring skills in resident assessments. Participants described important enabling factors such as managerial support, drivers for change, and feasibility of the intervention for the local nursing home. Barriers to implementing and sustaining the intervention were time constraints, lack of staff training, unsuitable electronic patient record system for care planning and high complexities of care and instabilities that are present in nursing homes.

Conclusions
Quality improvements in nursing homes are difficult to sustain. In order to offer residents high quality of care that meet their individual needs, it is important for management and nursing home staff to be aware of and understand factors that enable or constrain change.
Language eng
DOI 10.1186/s12913-019-4034-0
Indigenous content off
Field of Research 1117 Public Health and Health Services
0807 Library and Information Studies
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2019, The Author(s)
Persistent URL http://hdl.handle.net/10536/DRO/DU:30128768

Document type: Journal Article
Collections: Faculty of Health
School of Nursing and Midwifery
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