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

基本信息

批准号：
9905333
负责人：
BARBARA RESNICK
金额：
$ 31.85万
依托单位：
UNIVERSITY OF MARYLAND BALTIMORE
依托单位国家：
美国
项目类别：
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/9905333
关键词：
Activities of Daily Living Adoption Adverse event Assisted Living Facilities Belief Care given by nurses Caregivers Caring Cognitive Data Discipline of Nursing Disease Progression Education Effectiveness Elderly Environment Evaluation Event Evidence based intervention Exposure to Family Family Caregiver Focus Groups Fright Goals Health care facility 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 acute care base care systems caregiving cost decubitus ulcer 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

项目摘要

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。

项目成果

期刊论文数量（14）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Reliability and Validity of the Resident Satisfaction Index in Assisted Living.

辅助生活居民满意度指数的信度和效度。

DOI：
10.1177/0733464820943807
发表时间：
2021-06
期刊：
Journal of applied gerontology : the official journal of the Southern Gerontological Society
影响因子：
0
作者：
Holmes SD;Resnick B;Galik E;Gruber-Baldini A;Kusmaul N
通讯作者：
Kusmaul N

The Impact of Cognitive impairment on Clinical Symptoms, Physical Activity and Care Interactions among Residents in Assisted Living Settings.

认知障碍对辅助生活环境中居民的临床症状、体力活动和护理互动的影响。

DOI：
10.1177/10547738211040628
发表时间：
2022
期刊：
Clinical nursing research
影响因子：
1.7
作者：
Resnick,Barbara;Boltz,Marie;Galik,Elizabeth;Zhu,Shijun
通讯作者：
Zhu,Shijun

Testing of the Function Focused Environment Assessment and the Function Focused Policy Assessment in Assisted Living.

辅助生活中以功能为中心的环境评估和以功能为中心的政策评估的测试。

DOI：
10.1080/02763893.2018.1534180
发表时间：
2019
期刊：
Journal of housing for the elderly
影响因子：
0
作者：
Resnick,Barbara;Galik,Elizabeth;Boltz,Marie;Vigne,Erin;Holmes,Sarah;Fix,Steven;Zhu,Shijun;Lewis,Regina
通讯作者：
Lewis,Regina

Reliability and Validity of the Function-Focused Care Checklist for Caregivers.

DOI：
10.1097/rnj.0000000000000294
发表时间：
2021-05-01
期刊：
Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses
影响因子：
0
作者：
Resnick B;Boltz M;Galik E
通讯作者：
Galik E

The Impact of a Randomized Controlled Trial Testing the Implementation of Function-Focused Care in Assisted Living on Resident Falls, Hospitalizations, and Nursing Home Transfers.

随机对照试验测试辅助生活中功能集中护理的实施对居民跌倒、住院和疗养院转移的影响。