An Action Research to Optimize the Well-Being of Older People in Nursing Homes: Challenges and Strategies for Implementing a Complex Intervention

Bourbonnais, Anne; Ducharme, Francine; Landreville, Philippe; Michaud, Cécile; Gauthier, Marie-Andrée; Lavallée, Marie-Hélène

doi:10.1177/0733464818762068

Cited by 21 publications

(65 citation statements)

References 40 publications

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“…Another objective of this pilot study was to assess the feasibility and acceptability of the implementation of this approach. These results are presented elsewhere (Bourbonnais et al, 2018;Bourbonnais et al, 2017).…”

Section: Objectivesupporting

confidence: 56%

“…The implementation strategies involved, among other things, a sevenhour training session, case history synopses, using formal caregivers as local leaders, and regular follow-up on the implementation by registered nurses (RN) with master's degrees who served as study coordinators. These strategies are described elsewhere (Bourbonnais et al, 2018).…”

Section: Intervention Approachmentioning

confidence: 99%

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Effects of an Intervention Approach Based on the Meanings of Vocal Behaviours in Older People Living with a Major Neurocognitive Disorder: A Pilot Study

Bourbonnais

Ducharme

Landreville

et al. 2019

Science of Nursing and Health Practices - Science infirmière et

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Effets d'une démarche d'interventions basée sur les sens des comportements vocauxEffets d'une démarche d'interventions basée sur les sens des comportements vocaux de personnes âgées vivant avec un trouble neurocognitif majeur : une étude pilote de personnes âgées vivant avec un trouble neurocognitif majeur : une étude pilote Abstract Introduction: Vocal behaviours (VB) are frequent in long-term care facilities (LTCF) and have many negative consequences. Interventions to decrease VB have limited clinical impact. Objective: This pilot study aimed to provide preliminary evidence on the effects of an intervention approach based on the meanings of VB in older people living with a neurocognitive disorder in LTCF. Methods: A mixed methods action research study was used. Fourteen triads (n=43) made up of an older person who manifested VB, a family member, and formal caregivers were included. An approach based on the meanings of VB was implemented in five LTCF. Semistructured interviews took place with some participants. Tools were used at four-time points to measure five variables: the frequency of VB, the well-being of older people, the perceived disruptiveness of VB, the partnership-based decision-making and the empowerment felt by family and formal caregivers. Results: The approach improved the perception of family and formal caregivers toward older people. This led to habit changes that influenced positively the frequency of VB and the well-being of older people. Formal and family caregivers also perceived VB as less disturbing and felt more empowered relatively to VB. The attitude of formal caregivers toward families evolved positively. No other changes were noted on partnership-based decisionmaking. Discussion and conclusion: This study indicates the potential of this approach to improve the well-being of older people who manifested VB, their families, and formal caregivers. This approach could be implemented in LTCF, tested and adapted for other behaviours.

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Section: Objectivesupporting

confidence: 56%

Section: Intervention Approachmentioning

confidence: 99%

Effects of an Intervention Approach Based on the Meanings of Vocal Behaviours in Older People Living with a Major Neurocognitive Disorder: A Pilot Study

Bourbonnais

Ducharme

Landreville

et al. 2019

Science of Nursing and Health Practices - Science infirmière et

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“…Domain 1. Intervention characteristics Relative advantage was addressed in six articles (Appelhof et al, 2018;Boersma et al, 2016;Bourbonnais et al, 2018;Ellard et al, 2014;Van Haeften-Van Dijk et al, 2015;Lawrence et al, 2016). The added value of the intervention was having a shared method for multidisciplinary consultations (Boersma et al, 2016), and expected gains in care time led to increased implementation willingness and efforts of staff (Van Haeften-Van Dijk et al, 2015).…”

Section: Barriers and Facilitatorsmentioning

confidence: 99%

“…Barriers regarding high patient-to-caregiver ratios (Bourbonnais et al, 2018), and multiple levels of management made access to resources challenging (Latham and Brooker, 2017). Half of the articles found staff turnover/ absenteeism/fluctuations, shortages, and changing positions to be an impeding factor (Appelhof et al, 2018;Boersma et al, 2016 Networks and communications was mentioned by all but three articles (Borbasi et al, 2011;McAiney et al, 2007;Wingenfeld et al, 2011). Facilitators were communication and contact between staff members and across disciplines (Van Haeften-Van Dijk et al, 2015; Kovach et al, 2008;Stein-Parbury et al, 2012), an open communication climate (Quasdorf et al, 2016), and support within the team (Boersma et al, 2016;Latham and Brooker, 2017;Mekki et al, 2017).…”

Section: Domain 3 Inner Settingmentioning

confidence: 99%

Systematic review on barriers and facilitators of complex interventions for residents with dementia in long-term care

Kormelinck

Janus

Smalbrugge

et al. 2020

Int. Psychogeriatr.

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Objectives: Psychotropic drugs are frequently and sometimes inappropriately used for the treatment of neuropsychiatric symptoms of people with dementia, despite their limited efficacy and side effects. Interventions to address neuropsychiatric symptoms and psychotropic drug use are multifactorial and often multidisciplinary. Suboptimal implementation of these complex interventions often limits their effectiveness. This systematic review provides an overview of barriers and facilitators influencing the implementation of complex interventions targeting neuropsychiatric symptoms and psychotropic drug use in long-term care. Design: To identify relevant studies, the following electronic databases were searched between 28 May and 4 June: PubMed, Web of Science, PsycINFO, Cochrane, and CINAHL. Two reviewers systematically reviewed the literature, and the quality of the included studies was assessed using the Critical Appraisal Skills Programme qualitative checklist. The frequency of barriers and facilitators was addressed, followed by deductive thematic analysis describing their positive of negative influence. The Consolidated Framework for Implementation Research guided data synthesis. Results: Fifteen studies were included, using mostly a combination of intervention types and care programs, as well as different implementation strategies. Key factors to successful implementation included strong leadership and support of champions. Also, communication and coordination between disciplines, management support, sufficient resources, and culture (e.g. openness to change) influenced implementation positively. Barriers related mostly to unstable organizations, such as renovations to facility, changes toward self-directed teams, high staff turnover, and perceived work and time pressures. Conclusions: Implementation is complex and needs to be tailored to the specific needs and characteristics of the organization in question. Champions should be carefully chosen, and the application of learned actions and knowledge into practice is expected to further improve implementation.

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“…Individualised ecopsychosocial interventions, that is non‐pharmacological interventions, are recommended to understand these behaviours and care for the people who manifest them (National Institute for Health & Clinical Excellence, ; Zeisel, Reisberg, Whitehouse, Woods, & Verheul, ). However, this type of care process is difficult to implement consistently since it requires team work and continuity of care (Bourbonnais, Ducharme, et al, ; Gravel, Legare, & Graham, ; Wilkins, Pollock, Rochon, & Law, ).…”

Section: Introductionmentioning

confidence: 99%

Conditions and ethical challenges that could influence the implementation of technologies in nursing homes: A qualitative study

Bourbonnais

Rousseau

Lalonde

et al. 2019

Int J Older People Nursing

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Aim To explore the conditions that may influence the implementation of an interactive mobile application (app) and an intelligent videomonitoring system (IVS) in nursing homes (NHs) and the ethical challenges of their use. Background There is a lack of knowledge about implementing technologies in NHs and the ethical challenges that might arise. In past studies, nursing care teams expressed the need for technologies offering clinical support. Technologies like an IVS and an app could prove useful in NHs to prevent and manage falls and responsive behaviours. Design An exploratory qualitative study was conducted with care managers, family caregivers and formal caregivers in five NHs. Methods Each participant was shown a presentation of a potential app and a short video on an IVS. It was followed by an individual semi‐structured interview. A conventional content analysis was performed. Findings Potential users found it would be possible to implement these technologies in NHs even if resistance could be expected. To facilitate adoption and achieve clinical benefits, the implementation of technologies should be pilot‐tested, and coaching activities should be planned. Ethical risks were considered already present in NHs even without technologies, for example, risks to privacy. Strategies were proposed, for instance, to adapt the code of ethics and procedures. Some potential prejudices about the interest and abilities of older staff, nurses' aides, and family caregivers to use technology were identified. Conclusions Through rigorous and ethical implementation, technologies supporting clinical care processes could benefit older people living in NHs, as well as their relatives and the staff. Implications for practice Various strategies are proposed to successfully implement technologies. Effort should be made to avoid prejudices during implementation, and procedures should be adapted to mitigate possible ethical challenges.

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An Action Research to Optimize the Well-Being of Older People in Nursing Homes: Challenges and Strategies for Implementing a Complex Intervention

Cited by 21 publications

References 40 publications

Effects of an Intervention Approach Based on the Meanings of Vocal Behaviours in Older People Living with a Major Neurocognitive Disorder: A Pilot Study

Effects of an Intervention Approach Based on the Meanings of Vocal Behaviours in Older People Living with a Major Neurocognitive Disorder: A Pilot Study

Systematic review on barriers and facilitators of complex interventions for residents with dementia in long-term care

Conditions and ethical challenges that could influence the implementation of technologies in nursing homes: A qualitative study

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