Initiating Aha moments when implementing person-centered care in nursing homes: a multi-arm, pre-post intervention

Abstract

Background Comprehensive adoption of culture change via person-centered care (PCC) practices in nursing homes has been slow. Change such as this, requires transformation of organizational culture, frequently generating resistance and slow moving change. This study examined how nursing homes perceive their adoption of PCC practices across seven domains and how these perceptions change in response to an educational intervention embedded in a statewide program, Promoting Excellent Alternatives in Kansas nursing homes (PEAK 2.0). Given perception is an important feature of the change process, it was hypothesized that pre-adopters engaging in PEAK 2.0’s initial Foundation year (level 0) would have lower perceived PCC adoption following a year of education and exposure to PCC, whereas adopters (PEAK 2.0 level 1–5 homes) would have higher perceived PCC adoption following a year of participation in their respective level in the program. Methods A multi-arm, pre/post intervention study was conducted during the 2014 and 2015 years of the PEAK 2.0 program comparing pre-PCC adopters to adopters. Outcomes were self-ratings of perceived PCC implementation across seven domains of PCC at the beginning and end of the 2014–15 program year, after pre-adopters had received PCC education and adopters had implemented a year of PCC. Paired t-tests and mixed repeated-measures linear models, controlling for potential confounders, were employed to test the study hypotheses. Results Across all seven domains of PCC, pre-adopters rated their PCC implementation as significantly higher on pre-test (2014) than on post-test (2015). In contrast, adopters rated their PCC achievement as higher on post-test (2015) than on pre-test (2014). Conclusions Pre-adopters’ lower score following a year of education and exposure to PCC may reflect a shift in perceptions of PCC as a concept or a deeper conceptualization of PCC. Since perceptions or assumptions can serve as a source of resistance to change, redefinition or “unlearning” to make way for more accurate definitions of PCC could aid in reducing organizational resistance to implementation of PCC and thus improve the rate of adoption. Electronic supplementary material The online version of this article (10.1186/s12877-019-1121-3) contains supplementary material, which is available to authorized users.

Continuing education interventions about person-centered care targeted for nurses in older people long-term care: a systematic review

“…Pedagogical methods were at the core of the effectiveness of the continuing education interventions. Some of the studies educated "key nurses," leaving these nurses to help other nurses learn to implement change in their workplace [50,53,56,61]. There are some risks associated with using "key nurses" in this way, as the process of implementing person centered care requires an understanding of the origin and content of the concepts alongside the practical uses in care situations.…”

“…[42,48,68,70] video material e.g. [57,61,74] brainstorming [72] and role-playing [68,72] to achieve their preferred outcomes. Additionally, more student-centered approaches such as simulation-based nursing education interventions have been shown to improve critical and creative thinking [79] though simulation was only used in one reviewed study [72].…”

“…[42,57,75]. In other studies the content or delivery of the intervention may not have been appropriate [50,61,68]. Many other weaknesses were described in the studies reviewed.…”

“…This drop-out occurs, for example through the mortality of the residents, and nursing staff turnover [84,85]. Four studies did not report any positive outcomes from the continuing education interventions [50,55,61,68]. There were quite several studies that did not follow the reporting guidelines, in which case the primary and secondary measures and outcomes were not clearly mentioned [42, 44, 46-50, 57, 61, 63, 64, 67, 69, 74, 75].…”

“…Most of the continuing education interventions about person-centered care had positive effects (Table 2) but four studies indicated that the interventions did not have the any effect [50,53,61,68]. Medication themed intervention outcomes described a significant decrease in use of psychotropic drugs [36,73].…”