Resident-Directed Long-Term Care: Staff Provision of Choice during Morning Care

• Published in: The Gerontologist Vol. 51; no. 6; pp. 867 - 875
• Main Authors: Simmons, Sandra F, Rahman, Annie, Beuscher, Linda, Jani, Victoria, Durkin, Daniel W, Schnelle, John F
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.12.2011
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; Choice Behavior; Female; Geriatric Assessment - methods; Geriatric Nursing - standards; Health Facilities; Health Services; Health Services for the Aged - standards; Homes for the Aged - organization & administration; Homes for the Aged - standards; Humans; Institutionalized Persons; Interpersonal Communication; Long-Term Care - organization & administration; Male; Measures (Individuals); Nursing Homes; Nursing Homes - organization & administration; Nursing Homes - standards; Observation; Quality of Health Care - standards; Selection; Tennessee; Tennessee
• ISSN: 0016-9013; 1758-5341
• DOI: 10.1093/geront/gnr066

Purpose: To develop an observational protocol to assess the quality of staff-resident communication relevant to choice and describe staff-resident interactions as preliminary evidence of the usefulness of the tool to assess current nursing home practices related to offering choice during morning care provision. Design and Methods: This study included 73 long-stay residents in 2 facilities. Research staff conducted observations for 4 consecutive morning hours during targeted care activities (transfer out of bed, incontinence, dressing, and dining location). Observations were conducted weekly for 12 consecutive weeks. Staff-resident interactions were measured related to staff offers of choice and residents' responses. Results: Interrater agreement was achieved for measures of staff offers of choice (kappa = 0.83, p less than 0.001), type of choice provided (kappa = 0.75, p less than 0.001), and resident requests related to choice (kappa = 0.72, p less than 0.001). Observations over 2,766 care episodes during 4 aspects of morning care showed that staff offered residents choice during 18% of the episodes. Most observations (70%) were coded as staff offering "no choice." Implications: Nursing home staff can use a simplified version of this standardized observational tool to reliably measure staff-resident interactions related to choice during morning care provision as a first step toward improving resident-directed care practice.