Dissemination and Implementation of Function Focused Care for Assisted Living

传播和实施以功能为中心的辅助生活护理

• 批准号: 9247750
• 负责人: BARBARA RESNICK
• 金额: $ 31.82万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-01 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9247750
• 关键词: Activities of Daily Living; Acute; Adoption; Adverse event; Assisted Living Facilities; Belief; Care given by nurses; Caregivers; Caring; Cognitive; Data; Decubitus ulcer; Discipline of Nursing; Disease Progression; Education; Effectiveness; Elderly; Environment; Evaluation; Event; Evidence based intervention; Family; Family Caregiver; Focus Groups; Fright; Goals; Healthcare Systems; Hospitalization; Hospitals; Hour; Individual; Intervention; Knowledge; Length of Stay; Long-Term Care; Maintenance; Maryland; Massachusetts; Measures; Medication Management; Mentors; Methods; Modeling; Nurses; Nursing Homes; Nursing Research; Outcome; Pain; Pennsylvania; Physical activity; Policies; Preparation; Process; Quality of life; Randomized; Randomized Controlled Trials; Research; Resources; Services; Testing; Time; Training; Translations; Treatment Efficacy; Work; base; caregiving; cost; dissemination trial; effective intervention; efficacy trial; evidence base; experience; fall risk; falls; functional decline; implementation trial; improved; improved functioning; instrumental activity of daily living; multiple chronic conditions; prevent; public health relevance; sedentary; social; social cognitive theory; theories; volunteer

 DESCRIPTION (provided by applicant): Assisted living (AL) settings provide homelike environments for individuals who need help with activities of daily living (ADL) or instrumental ADLs (e.g., medication management) but for whom 24-hour nursing care is not necessary. Nearly 40% of residents in AL settings require assistance with three or more ADLs and most need help with meal preparation and medication management. They tend to experience even more functional decline and spend less time in physical activity than residents in nursing facilities. This decline is not completely related to disease progression. Rather, it is due to the way care is provided and the tendency caregivers have to perform the care task for the resident rather than allowing him or her to do the activity. In addition, there is an excessive fear among older adults, families and caregivers that engaging in physical activity will result in adverse events (e.g., falls). The persistent decrease in function and physical activity in residents actualy increases their risk for falls, pain, pressure ulcers, further functional decline, hospitalizations nursing home placement, and decreases quality of life. Function Focused Care for AL (FFC-AL) is an approach to care such that residents are helped to participate in functional and physical activity throughout the course of the day. FFC-AL is a four-step theory-based approach including: (1) Environment and Policy Assessments; (2) Education; (3) Establishing Resident Service Plans; and (4) Mentoring and Motivating Direct Care Workers and Residents. In efficacy trials, FFC-AL was implemented over 12 months by a Research Nurse Facilitator working with an identified setting champion. Residents in settings exposed to FFC-AL maintained or improved function, spent more time in physical activity and were less likely to be transferred to acute care facilities. Unfortunately, implementing effective care approaches like FFC-AL into AL settings is challenging due to setting and resident related factors. To overcome these challenges we developed a theory based approach using Social Cognitive Theory, the Social Ecological Model and the Evidence Integration Triangle (EIT). This approach, referred to as FFC-AL-EIT, includes the involvement of setting stakeholders, uses resources currently available in AL settings and allows for an individualized focus on setting specific challenges. This study will test the dissemination and implementation of FFC-AL-EIT across 96 AL settings in Maryland, Pennsylvania and Massachusetts and will include 960 residents. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) model will be used to evaluate outcomes. By using a theory based approach and building off prior experience in disseminating and implementing function focused care, this study will add to what is known about dissemination and implementation of effective interventions in AL settings and serve as a model for other care approaches.

 描述（由申请人提供）：辅助生活 (AL) 环境为需要日常生活活动 (ADL) 或工具性 ADL（例如药物管理）帮助但不需要 24 小时护理的个人提供温馨的环境。 AL 机构中近 40% 的居民需要 3 项或以上 ADL 方面的帮助，并且大多数人需要膳食准备和药物管理方面的帮助，与护理机构中的居民相比，他们往往会经历更多的功能衰退，并且花在身体活动上的时间更少。下降并不完全与疾病进展相关。 提供护理的方式以及护理人员倾向于为居民执行护理任务，而不是允许他或她进行活动。此外，老年人、家庭和护理人员过度担心参加体力活动会导致身体活动。居民功能和体力活动的持续下降实际上增加了他们发生跌倒、疼痛、压疮、进一步功能下降、住院疗养院以及降低生活质量的风险。 AL (FFC-AL) FFC-AL 是一种帮助居民参与全天功能和身体活动的护理方法，是一种基于理论的四步方法，包括： (1) 环境和政策评估； (2) 教育； (3) 制定住院医师服务计划；以及 (4) 指导和激励直接护理人员和住院医师 在功效试验中，研究护士协调员与确定的住院医师一起在暴露于环境的环境中实施了 12 个月。 FFC-AL 维持或改善了功能，花更多的时间进行体力活动，并且不太可能被转移到急性护理机构。不幸的是，由于环境和居民相关因素，在 AL 环境中实施像 FFC-AL 这样的有效护理方法具有挑战性。为了克服这些挑战，我们使用社会认知理论、社会生态模型和证据整合三角（EIT）开发了一种基于理论的方法，这种方法被称为 FFC-AL-EIT，包括设置利益相关者的参与，使用当前可用的资源。在 AL 设置中并允许这项研究将测试 FFC-AL-EIT 在马里兰州、宾夕法尼亚州和马萨诸塞州 96 个 AL 环境中的传播和实施情况，并将包括 960 名居民。 AIM）模型将用于评估结果，通过使用基于理论的方法并借鉴先前在传播和实施以功能为中心的护理方面的经验，本研究将增加对 AL 环境中有效干预措施的传播和实施的了解。作为其他护理方法的典范。