Managing the deteriorating nursing home resident after the introduction of a hospital avoidance programme: a nursing perspective

Abstract

Nursing staff welcomed the programme and benefitted from its implementation. However, strategies must be explored to accommodate the staffing needs associated with providing emergency and subacute care in the nursing home setting.

Nursing staff intentions towards managing deteriorating health in nursing homes: A convergent parallel mixed‐methods study using the theory of planned behaviour

“…Using both methods was appropriate because a single data set alone did not supply enough information to answer the research question. The topic was underexplored (Lamb et al., ; O'Neill et al., ; Ouslander & Maslow, ), so qualitative data were determined essential to understanding the nursing staff experience (Corbin & Strauss, ), while quantitative data were considered as important to gauge attitudes, subjective norms and perceived behavioural control. Thus, a pragmatic theoretical approach was adopted and inclusion of the TPB as a conceptual framework coalesced the two methods and strengthened the study design (Creswell & Clark, ).…”

“…Components of the program included decision‐support tools, advanced clinical skills training, specialist clinical support and medical equipment. The Subacute Program focuses staff education and support on eight site specific clinical conditions that commonly lead to hospitalisation in the nursing home setting and uses a colour‐coded traffic light system to guide detection and response to signs of deteriorating health (O'Neill et al., ). While the focus of this study is not about the outcomes of the Subacute Program itself, review of the program determined there were fewer hospital transfers and more subacute care for residents provided in the facility one year after the program's implementation when compared against two previous years (Parkinson, O'Neill, Dwyer, & Reid‐Searl, ).…”

“…Programs that provide the tools and resources necessary for nursing homes to prevent hospitalisations have been developed under a variety of labels, including hospital avoidance, admission avoidance (Crilly, Chaboyer, Wallis, Thalib, & Polit, ), quality improvement (Ouslander et al., ), subacute program (O'Neill, Dwyer, Reid‐Searl, & Parkinson, ) and clinical pathways (Carusone, Loeb, & Lohfeld, ), with the main focus being early detection of deteriorating health and a timely and appropriate response. In this article, the programs will be referred to generically as “hospital avoidance programs.” Components of the programs vary but may include training and decision‐support resources for the nursing staff; diagnostic equipment; timely access to, or assessment by, a physician, nurse practitioner, mobile health team or telephone contact; advance care planning or palliative care support; and resources to provide a higher level of subacute care than would otherwise be available (O'Neill et al., ; Ouslander et al., ; Unroe et al., ). While published reports on the outcomes of these types of programs have limitations (Arendts et al., ), there have been reports of reductions in the number of hospitalisations and length of hospital stay (Crilly et al., ; Ouslander et al., , ; Tena‐Nelson et al., ).…”

“…Nursing staff perform a pivotal role in hospital avoidance programs because they are typically the first to detect and act upon signs of deteriorating health (Abrahamson, Mueller, Davila, & Arling, ; Carusone et al., ; Lamb et al., ; O'Neill, Parkinson, Dwyer, & Reid‐Searl, ; O'Neill, Reid‐Searl, Dwyer, & Parkinson, ; O'Neill et al., ). Protocols that are part of hospital avoidance programs are helpful because signs and symptoms of deteriorating health can be difficult to recognise and manage in older people (Montgomery, Mitty, & Flores, ).…”

“…Experience has shown these types of programs must align with the facility culture (Unroe et al., ) and consider the perceptions of the nursing staff (Carusone et al., ; Lamb et al., ). The few studies reporting on nursing staff perspective around programs aimed at preventing unnecessary hospitalisation indicate nursing staff support these initiatives (Abrahamson et al., ; Carusone et al., ; Davila et al., ; Nelson, Wild, & Szczepura, ; O'Neill et al., ).…”