Staff Engagement for Practice Change in Long-Term Care: Evaluating the Feasible and Sustainable Culture Change Initiative (FASCCI) Model

Abstract

BackgroundPerson-centred care (PCC) is described as a care philosophy in which a positive relationship is established between a resident and staff member that respects the care recipient's preferences and life history, honours identity, and enables engagement in meaningful activity (Fazio et al., 2018). Research in long-term care (LTC) homes demonstrates that interventions aimed at increasing the provision of PCC, but not addressing contextual and system issues (e.g., deeply rooted care routines and regulatory standards that impede individuality, resident choice and staff flexibility), most often fail (Caspar et al., 2016). There is growing evidence demonstrating that the implementation of PCC in practice requires a multilevel, systems approach (Brooker, 2007;Evans, 2017). Review of the literature indicates that the following organizational factors may be especially salient in their ability to influence the extent to which PCC is really improved in practice:1. The presence of leaders and managers who embrace a leadership style of 'supporting and valuing staff' combined with being 'responsive to staff needs' and offering 'solution-focused approaches' to care decisions (Caspar et al., 2017a;Kirkley et al., 2011;McGilton, 2010;Sjogren et al., 2017). 2. The cultivation and implementation of empowered workforce practices that enable and encourage

Sequential relationships of food intake in nursing home residents with dementia: Behavioural analyses of videotaped mealtime observations

“…Findings of this study reinforce the need for feasible, easy‐to‐implement and innovative interventions focusing on initiating and maintaining successful intake flow as early as possible, supporting independence by providing continuous staff engagement, and allowing adequate time between intake episodes during mealtime. Such reinforcement may require a multilevel approach including supportive systems and team environment, and further facilitate the transition of the long‐term care philosophy, practice and policy from task‐centred to person‐centred, which are highly recommended for people with dementia (Caspar et al, 2020). These behavioural interventions, rather than the current care practice of providing full assistance by staff to residents and rushing residents during mealtime, have potential to ensure adequate intake.…”

“…Such reinforcement may require a multilevel approach including supportive systems and team environment, and further facilitate the transition of the long-term care philosophy, practice and policy from task-centred to person-centred, which are highly recommended for people with dementia (Caspar et al, 2020). These behavioural interventions, rather than the current care practice of providing full assistance by staff to residents and rushing residents during mealtime, have potential to ensure adequate intake.…”

Montessori mealtimes for dementia: A pathway to person-centred care

“…Multi-component interventions that target mealtime culture, organisational policies and care practices, as well as the social and physical environment and the individual care needs of residents, represent highly complex interventions, requiring conceptual and practical frameworks to support the change process and translation of person-centred mealtime practices into routine care (Caspar et al, 2020; Chaudhury et al, 2017; Fetherstonhaugh et al, 2019; Reimer & Keller, 2009; Watkins et al, 2017). The Montessori approach has been identified as one potential framework to provide a pathway to service-wide person-centred care, with potential to significantly improve the mealtime experience (Brush, Douglas, & Bourgeois, 2018).…”

“…To meet the medical, nutritional and psychosocial needs of residents, mealtime care should be holistic and person-centred, providing the opportunity for choice, supporting independence, showing respect for individual residents, and promoting the social side of eating and drinking (Reimer & Keller, 2009). Implementing person-centred mealtime care is, however, inherently challenging given the complex and multi-factorial nature of both the structure of mealtimes and the motor and cognitive skills needed for safe and efficient oral intake (Caspar et al, 2020; Hung & Chaudhury; 2011; Reimer & Keller, 2009; Watkins et al, 2017). Care staff play a central role in providing feeding assistance and enabling resident choice, nutrition and enjoyment of food, yet organisational structures and systems, such as insufficient staff supports and time pressure, can undermine the mealtime experience and the quality of interactions between staff and residents (Milte, et al, 2017; Watkins et al, 2017).…”