Adapting Montessori Activity Programming for Veterans Living in Community Living Centers

为居住在社区生活中心的退伍军人调整蒙特梭利活动计划

• 批准号: 9768230
• 负责人: Michelle M. Hilgeman
• 金额: --
• 依托单位: TUSCALOOSA VETERANS AFFAIRS MEDICAL CTR
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-03-01 至 2020-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9768230
• 关键词: Address; Affect; Antipsychotic Agents; Behavior; Behavioral; Caring; Climate; Clinical; Cognitive; Collaborations; Communities; Competence; Complex; Data; Dementia; Dependence; Diagnosis; Discipline of Nursing; Disease; Dissemination and Implementation; Documentation; Educational process of instructing; Energy Intake; Environment; Evidence based intervention; Fostering; Frequencies; Funding; Geriatrics; Guidelines; Healthcare; Human; Individual; Intervention; Joints; Knowledge; Left; Life; Link; Long-Term Care; Longevity; Medical; Mental Health; Mental disorders; Methods; Mission; Movement; Nursing Homes; Outcome; Patient-Centered Care; Patients; Perception; Performance; Periodicity; Personal Satisfaction; Persons; Phase; Population; Population Heterogeneity; Quality of Care; Quality of life; Recreation; Reporting; Research; Research Personnel; Role; Sampling; Site; Social Behavior; Social Environment; Social outcome; Stress; Structure; Support System; System; Testing; Time; Training; Veterans; Visit; Vulnerable Populations; Work; advanced dementia; base; cognitive ability; community living; density; evidence base; follow-up; implementation strategy; implementation study; improved; innovation; learning strategy; male; member; memory care; operation; peer; physical conditioning; physically handicapped; programs; reading ability; satisfaction; sedative; severe mental illness; social; success; symposium; time use; tool; uptake

Background: Providing Veterans “personalized, proactive, patient-driven health care” is central to VHA’s Blueprint for Excellence’s mission. Enabling Community Living Center (CLC) residents to use their time meaningfully constitutes a key facet of this care. Yet busy frontline staff concentrating on medical care frequently overlook this fundamental human need, resulting in poorer resident clinical and social outcomes. Montessori-based Activity Programming (MAP) is a community nursing home- developed structured, evidence-based intervention that fills this critical gap. It enables resident engagement in structured, meaningful activities using clearly outlined principles and strategies focusing on resident strengths. MAP is effective for a variety of resident outcomes: social behavior, basic cognitive abilities, engagement, caloric intake, antipsychotic and sedative use, and behavioral disturbances. This proposal will address three issues before MAP can be used successfully with Veterans in CLCs: (1) adapting it for CLCs’ heterogeneous population; (2) developing a delivery strategy for the complex and difficult- to-change CLC system that is not dependent on MAP’s current lengthy, in-person training; and (3) testing the adapted program and strategy to finalize it for regional or national roll out Objectives: This 3-year pre-implementation study will address these gaps across three aims. Aim 1 (Phase 1): Adapt MAP for the CLC population (MAP-VA) and define the delivery method in collaboration with staff at 2 CLCs. Aim 2 (Phase 2): Compare onsite and remote implementation strategies for the implementation guide at 6 sites. Aim 3 (Phase 3): Finalize a revised, practical, and effective MAP-VA delivery guide to enable sustainable dissemination and implementation. Methods: The study will take place in 3 phases using mixed-methods and a purposive sample of CLCs. In Phase 1 (12 months) we will visit 2 sites to gather data to adapt the materials and develop the delivery guide. In Phase 2 (18.5 months) we will have 6 sites implement the guide, each over a 6-month period. We will compare: (a) an onsite strategy at 3 sites, involving in-person, on-the-ground training prior to and during the implementation period, and (b) a remote strategy at 3 sites, where training and follow up will be done via conference calls and LiveMeeting. In Phase 3 (5.5 months) we will revise and finalize the guide and implementation plan, making it ready for regional / national roll-out. Anticipated Impacts: Over 40,000 Veterans receive care in VHA CLCs nationwide each year. Efforts to improve care quality have resulted in the “culture change” movement over the last decade, which has been fully embraced by the VA. Essential to the success of this shift in treatment climate is careful consideration of the intimate link between staff-related factors and resident outcomes in long-term care settings. Evidence-based staff training on activity delivery is urgently needed to provide more appropriate care for Veterans, over half of which are diagnosed with mental health disorders and / or dementia. Recreation therapists alone cannot provide the density of activity required. Meaningful time use has been shown to benefit physical health, longevity, well-being, and quality of life. Interdisciplinary frontline staff with the most patient contact, including nursing assistants, need evidence-based practical tools and strategies for engaging Veterans in meaningful activities that promote quality of life and reduce behavior disturbances. MAP-VA may fill this gap. Interim deliverables and final products will be shared with operations partners who are collaborating on this project as Advisory Panel members. The knowledge gained from this study will be of immediate applicability to CLCs nationwide and will be helpful for guiding further improvements in patient-centered care in VHA.

背景：提供退伍军人“个性化，积极主动，以患者为导向的医疗保健”是至关重要的 VHA的《卓越使命》的蓝图。使社区生活中心（CLC）居民使用 他们的时间有意义地构成了这一护理的关键方面。但是忙碌的前线工作人员专注于 医疗保健经常忽视这种基本的人类需求，导致较贫穷的居民临床和 社会成果。总部位于蒙台梭利的活动编程（MAP）是社区护士家庭 - 开发的结构化，基于证据的干预措施填补了这一关键空白。它使居民 使用清晰概述的原则和策略专注于结构化的有意义的活动 关于居民的优势。地图对各种居民的结果有效：社会行为，基本认知 能力，参与度，热量摄入量，抗精神病药和镇静用途以及行为灾难。这 建议将在CLC中成功使用地图之前解决三个问题：（1）调整 它适用于CLC的异质人群； （2）为复杂而困难制定交付策略 - 不取决于MAP的当前长度，面对面培训的CLC系统； （3） 测试针对区域或国家推出的改编计划和策略 目的：这项为期三年的实施前研究将解决三个目标的这些差距。目标1（阶段 1）：适应CLC总体（MAP-VA）的地图，并与 2个CLC的工作人员。目标2（阶段2）：比较现场和远程实施策略 在6个站点的实施指南。 AIM 3（第3阶段）：最终确定经过修订，实用和有效的MAP-VA 实现可持续传播和实施的交付指南。 方法：该研究将使用混合方法和自然的CLC样本在3个阶段进行。 在第1阶段（12个月）中，我们将访问2个站点以收集数据以调整材料并开发 送货指南。在第2阶段（18.5个月）中，我们将有6个站点实施该指南，每个指南超过6个月 时期。我们将比较：（a）在3个网站上进行现场策略，涉及实地，现场培训 在实施期之前和期间 随访将通过电话会议和秘密来完成。在第3阶段（5.5个月）中，我们将修改和 最终确定指南和实施计划，使其为区域 /国家推出做好准备。 预期的影响：每年有40,000多名退伍军人在全国范围内接受VHA CLC的护理。努力 改善护理质量已导致过去十年中的“文化变化”运动， 我们被弗吉尼亚州完全拥抱。对这种治疗环境转变的成功至关重要 考虑员工相关因素与居民结果之间的亲密联系 设置。迫切需要进行基于证据的员工培训有关活动交付的培训，以提供更多 对退伍军人的适当护理，其中一半被诊断出患有精神疾病和 /或 失智。仅娱乐治疗师不能提供所需的活动密度。有意义的时间 已证明使用可以使身体健康，寿命，福祉和生活质量受益。跨学科 包括护士助理在内的最患者联系的一线人员需要循证实用 使退伍军人参与有意义的活动的工具和策略，以促进生活质量和 减少行为障碍。 MAP-VA可能会填补此空白。临时可交付成果和最终产品将是 与正在作为咨询小组成员合作的运营合作伙伴共享。这 从这项研究中获得的知识将直接适用于全国CLC，将是 有助于指导VHA中以患者为中心的护理的进一步改善。