Evaluation of the Restorative Care Education and Training Program for Nursing Homes

Abstract

RÉSUMÉLes soins de rétablissement visent à rompre le cycle de la dépendance et du déclin fonctionnel dans les maisons de soins infirmiers en répondant aux besoins particuliers des divers résidents. Le programme RCET (Restorative Care Education and Training) comprend un atelier de cinq semaines ainsi qu'un manuel d'information destiné autant aux superviseurs qu'aux prestataires de soins directs. Ce document décrit l'approche du programme RCET et présente la mise en oeuvre, les procédés et les résultats d'une évaluation quasi-expérimentale portant sur 42 résidents qui ont reçu des soins réguliers dans six lieux d'intervention différents et six établissements de « liste d'attente ». Les données de base ont permis de confirmer que le personnel mettait surtout l'accent sur les résidents qui souffraient de handicaps fonctionnels substantiels. En quatre mois, les résidents qui ont reçu des soins de rétablissement ont vu plusieurs de leurs indicateurs relatifs aux résultats fonctionnels s'améliorer de façon considérable, tandis que dans le groupe de contrô le, les sujets voyaient plusieurs de leurs fonctions décliner. Les entrevues menées auprès de la direction de l'établissement et du personnel ayant participé à l'étude ont permis de dégager certaines orientations visant à modifier le programme RCET, ainsi que certaines perspectives relatives aux possibilités et aux défis à relever afin de mettre en oeuvre des activités de soins de rétablissement dans des maisons de soins infirmiers. ABSTRACTRestorative care attempts to break the cycle of dependency and functional decline in nursing homes by addressing individual resident needs. The Restorative Care Education and Training (RCET) Program consists of a five-week workshop and resource manual for both supervisory and direct care staff. This paper describes the RCET approach and presents the implementation, process, and quasi-experimental outcome evaluation findings with 42 residents from six intervention sites and six ''wait-list'' facilities who received usual care. Baseline data supported the fact that staff primarily targeted residents with substantial functional impairments. Over four months, residents who received restorative care improved significantly on several functional outcome indicators, while the comparison sample declined in several areas of functioning. Interviews with facility directors and participating staff provided direction for modifying the RCET and insight regarding opportunities and challenges when implementing restorative care activities in nursing homes.

A Systematic Review of Interventions to Change Staff Care Practices in Order to Improve Resident Outcomes in Nursing Homes

“…Ten studies focused on changing the philosophy or aspects of care culture, such as person-centered care, emotion-oriented care, awareness oriented care and restorative care [ 86 – 103 ](see Table 11 ). One study offered training only [ 91 ], and one changed staff responsibilities and care procedures [ 93 ]. The remaining studies combined training with other intervention components such as mentoring or support [ 86 , 87 , 89 , 92 , 97 , 99 , 100 , 102 ] and audit and feedback [ 86 , 89 ].…”

“…Seven out of eight studies that measured whether staff changed their behavior showed at least some improvements [ 86 , 90 , 91 , 94 , 96 , 98 , 101 ]. There did not appear to be a pattern in the intervention components that produced successful interventions.…”

Mobility of Vulnerable Elders (MOVE): study protocol to evaluate the implementation and outcomes of a mobility intervention in long-term care facilities

“…Originally designed with rehabilitation populations in mind [57], the reliability and validity of the FIM has been assessed with older adults in acute care [59] and the community [58,60] with demonstrated reliability in each of these settings [61]. More recently the FIM has been used in a LTC setting [21,62,63] and has been compared with the Resident Assessment Instrument [64-68]. Eight responsiveness studies all found the physical but not the cognitive subscales to be responsive to change [59,65].…”

Nursing Home Resident Outcomes from the Res‐Care Intervention

“…Most of the studies included single sites or were quasiexperimental. [21][22][23][24] There have been a few randomized trials that have addressed restorative care activities. [25][26][27] These studies focused on morning care activities in residents with cognitive and behavioral problems, and the findings indicated that, with appropriate cues and nursing care, individuals with significant cognitive impairment could increase function with regard to morning care activities.…”