A Systematic Review of Interventions to Change Staff Care Practices in Order to Improve Resident Outcomes in Nursing Homes

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A Systematic Review of Interventions to Change Staff Care Practices in Order to
Improve Resident Outcomes in Nursing Homes
Introduction:
It has been found that different studies have been introduced in order to provide
adequate evidence for the effectiveness of good practice to improve the prolong residential
care for the older people in the nursing homes, residential aged care home and long-term care
homes. However, in the research and practice unconscionable gap has been detected. After
the promotion of patient centred care the culture of changing effort has been spread widely in
the nursing homes of America. Still, it is unclear that whether the efforts in implementation
could bring changes within the staffs and the clinical practice. The effectiveness of practice
changes regarding the service quality and residential health outcomes are not clear as well. In
this regards some effective barriers in the way of implementation of good practice have been
recognized, for example, lack of innovation, high cost, lack of education of the staffs,
resistance in leadership and high rate of employee turnover. In addition lack of evidence
regarding the way of changing the behaviour of the health care staffs and changing the
culture of organization has contributed in the development of barriers in an effective manner.
However, implementation has been considered as one of the most important element to
bridge the lag between the practice and improved health service. Thus, it is important to
introduce further study in order to identify the proper way of implementing changes in the
clinical practice and behaviour of the staffs to improve the health outcomes as it was
identified by the previous systemic reviews that such interventions could help to achieve
successful outcomes (Low et al., 2015).

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PICO question:
Do the health care staffs with changed behaviour (P) using good practice that helps to
change behaviour (I) as compare to practice that is not associated with changed behaviour (C)
improve the long term residential care (O) within 6 months (T)?
PICO Table:
Population (P): Health care staffs with changed behaviour.
Intervention (I): Change the behaviour of the health care staffs and organizational culture and
introduce good practice in the health care.
Comparison (C): Practice that is not associated with changed behaviour of health care staffs.
Outcomes (O): Improved long term care and positive residential health outcomes in the
residential care of older people or nursing homes.
Time (T): 6 months.
Literature review:
Various studies have ensured that introducing good practice could help to improve the
residential long term care and help to achieve desired health outcomes. However, several
barriers have been found that restrict the changes in the clinical practice and create barriers in
the way of implementation of good practice. However, it has been found that implementation
of good practice could play a vital role in order to close the gap within the practice. Previous
literatures have examined the effectiveness of significant interventions in order to enhance
the residential health outcomes. For example, the previous researches have indicated that
intervention such as training of the health care staffs regarding the management of dementia
and psychological and behavioural effect has helped to improve the service provided to such

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patients. Such studies have focused on the efficiency of the interventions however, they did
not identify the interventions that lead to the changing practice in the health care. Thus, the
systemic review provided by Low et al., (2015) aimed to find out the interventions that could
help to change the behaviour and practice of the nursing staffs. The researchers have focused
on three main objectives such as to recognize and elaborate the studies systematically that
have examined the effectiveness of interventions to change the practice of health acre staffs
in order to improve residential health outcomes, to find out the elements of the strategies that
have contributed effectively to the successful approaches of staff practice in the health care
centres and to recognize the facilitators and barriers of the approach of change staff practice.
In order to conduct the systematic review the researchers have used effective
methodology and the method was chosen with the consultation of the librarian of an
information service university. It has helped to process the relevant previous studies in an
effective manner. The researchers have used effective databases such as MEDLINE,
CINAHL, PubMed and PsycINFO. English language and date from 1990 to 2013 has been
used. Search terms included nursing home, residential care, long-term, implementation,
organizational change, professional development and others have used to find out the related
literatures from the selected databases. The inclusion criteria includes studies that are
conducted in the residential care and nursing home, study that have used randomised control
trial or quasi experimental trial, studies that have used 3 or more sites, studies that have
aimed to change the practice of health care staffs and the studies included outcomes such as
change in the behaviour of the health care staffs, improved clinical and health outcomes and
satisfaction residential care. The researchers have screened the previous literatures and
identified the full text articles that have fulfilled the inclusion criteria and reviewed them to
derive the conclusion of the systematic review. Data has been collected regarding the
facilitators and barriers, different theoretical explanations of changed behaviour and some