Skilled nursing facilities (SNFs) are organizations that represent complex adaptive systems, offering barriers to the implementation of quality improvement (QI) initiatives. The current article describes the authors’ efforts to use the approach of reflective adaptive process to implement a new model of care (i.e., the Skilled Heart Unit Program) for effective heart failure (HF) care in one SNF. A team of stakeholders from the local hospital system and a local SNF was convened to design and implement this new model. Evaluation of the implementation processes confirmed the value of the implementation approach, which centered on team-based approaches, staff engagement, and flexibility of processes to respect the SNF’s needs and culture. Interviews with facility staff and the administrator revealed their perceptions that the strategy resulted in better HF care, enhanced teamwork between staff and clinicians, and improved staff job satisfaction. This work provides a unique blueprint of strategic QI implementation for patients with HF in the SNF setting. [
Journal of Gerontological Nursing, 41
(5), 26–33.]
Findings from this study of 54 subjects who used the BKAT-3 in their professional practice indicate that it is being used most frequently in orientation programs conducted in critical care units, and that content and scores of the BKAT have resulted in changes in those programs. Scores are also being used for placement of nurses with previous critical care experience. In addition, findings from this study and from the literature indicate that research continues to be conducted using scores on the BKAT as a dependent variable, and that moderate to moderately high correlations exist between intended and actual use of the BKAT.
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