A randomized controlled trial to evaluate the effectiveness of a staff training program to implement consumer directed care on resident quality of life in residential aged care

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Abstract

Background

Residential Aged Care Facilities (RACFs) are moving towards a Consumer Directed Care (CDC) model of care. There are limited examples of CDC in ageing research, and no evaluation of a comprehensive CDC intervention in residential care was located. This study will implement and evaluate a staff training program, Resident at the Center of Care (RCC), designed to facilitate and drive CDC in residential care.

Methods

The study will adopt a cluster randomized controlled design with 39 facilities randomly allocated to one of three conditions: delivery of the RCC program plus additional organizational support, delivery of the program without additional support, and care as usual. A total of 834 staff (22 in each facility, half senior, half general staff) as well as 744 residents (20 in each facility) will be recruited to participate in the study. The RCC program comprises five sessions spread over nine weeks: Session 1 clarifies CDC principles; Sessions 2 to 5 focus on skills to build and maintain working relationships with residents, as well as identifying organizational barriers and facilitators regarding the implementation of CDC. The primary outcome measure is resident quality of life. Secondary outcome measures are resident measures of choice and control, the working relationship between resident and staff; staff reports of transformational leadership, job satisfaction, intention to quit, experience of CDC, work role stress, organizational climate, and organizational readiness for change. All measures will be completed at four time points: pre-intervention, 3-months, 6-months, and 12-month follow-up. Primary analyses will be conducted on an intention to treat basis. Outcomes for the three conditions will be compared with multilevel linear regression modelling.

Discussion

The RCC program is designed to improve the knowledge and skills of staff and encourage transformational leadership and organizational change that supports implementation of CDC. The overarching goal is to improve the quality of life and care of older people living in residential care.

Trial registration

ACTRN12618000779279; Registered 9 May 2018 with the Australian and New Zealand Clinical Trials Registry (ANZCTR; http://www.anzctr.org.au/).

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Most cited references 22

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Readiness for Organizational Change: The Systematic Development of a Scale

D. T. Holt, A A Armenakis, H. Feild … (2007)

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Motivational predictors of weight loss and weight-loss maintenance.

Edward L Deci, Jason G. Williams, Scott R. Freedman … (1995)

Self-determination theory proposes that behavior change will occur and persist if it is autonomously motivated. Autonomous motivation for a behavior is theorized to be a function both of individual differences in the autonomy orientation from the General Causality Orientations Scale and of the degree of autonomy supportiveness of relevant social contexts. We tested the theory with 128 patients in a 6-month, very-low-calorie weight-loss program with a 23-month follow-up. Analyses confirmed the predictions that (a) participants whose motivation for weight loss was more autonomous would attend the program more regularly, lose more weight during the program, and evidence greater maintained weight loss at follow-up, and (b) participants' autonomous motivation for weight loss would be predicted both by their autonomy orientation and by the perceived autonomy supportiveness of the interpersonal climate created by the health-care staff.

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Residents' experiences of interpersonal factors in nursing home care: a qualitative study.

Sigrid Nakrem, Anne Guttormsen Vinsnes, Arnfinn Seim (2011)

With life expectancy lengthening, the number of those who will require care in a nursing home will increase dramatically in the next 20 years. Nursing home residents are frail older adults with complex needs, dependent on advanced nursing care. Long-term residents in nursing homes have long-term relationships with the nurses, which require a unique approach to the interpersonal aspects of nursing care. Understanding what is experienced as care quality, including quality of interpersonal processes, requires insight into the residents' perspectives for best value in care to be realized. Main objective was to describe the nursing home residents' experience with direct nursing care, related to the interpersonal aspects of quality of care. A descriptive, exploratory design was used. Four public municipal nursing homes in Norway with long-term residents were purposely selected for the study. Fifteen mentally lucid residents were included. The inclusion criteria were aged 65 and over, being a resident of the nursing home for one month or longer, and physical and mental capacity to participate in the interview. In-depth interviews with the residents were performed. The transcribed interviews were analyzed using meaning categorizing. The residents emphasized the importance of nurses acknowledging their individual needs, which included need for general and specialized care, health promotion and prevention of complications, and prioritizing the individuals. The challenging balance between self-determination and dependency, the altered role from homeowner to resident, and feelings of indignity and depreciation of social status were key issues in which the residents perceived that their integrity was at risk in the patient-nurse interaction and care. Psychosocial well-being was a major issue, and the residents expressed an important role of the nursing staff helping them to balance the need for social contact and to be alone, and preserving a social network. Quality nursing care in nursing home implies a balanced, individual approach to medical, physical and psychosocial care, including interpersonal aspects of care. The interpersonal relationship between resident and nurse implies long-term commitment, reciprocal relationship on a personal level and interpersonal competence of the nurses to understand each resident's needs. Copyright © 2011 Elsevier Ltd. All rights reserved.

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Author and article information

Contributors

Marita P. McCabe:

ORCID: http://orcid.org/0000-0002-4989-8582

mmccabe@swin.edu.au

Elizabeth Beattie: elizabeth.beattie@qut.edu.au

Gery Karantzas: gery.karantzas@deakin.edu.au

David Mellor: david.mellor@deakin.edu.au

Kerrie Sanders: ksanders@unimelb.edu.au

Lucy Busija: lucy.busija@monash.edu.au

Belinda Goodenough: belgood@uow.edu.au

Michelle Bennett: michelle.bennett@acu.edu.au

Kathryn von Treuer: kathryn.vontreuer@cairnmillar.org.au

Jessica Byers: jbyers@swin.edu.au

Journal

Journal ID (nlm-ta): BMC Geriatr

Journal ID (iso-abbrev): BMC Geriatr

Title: BMC Geriatrics

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2318

Publication date (Electronic): 23 November 2018

Publication date PMC-release: 23 November 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 287

Affiliations

[1 ]ISNI 0000 0004 0409 2862, GRID grid.1027.4, School of Health Sciences, , Swinburne University of Technology, ; H95 PO BOX 218, Hawthorn, VIC 3122 Australia

[2 ]ISNI 0000000089150953, GRID grid.1024.7, The Dementia Centre for Research Collaboration, , Queensland University of Technology, ; Brisbane, Australia

[3 ]ISNI 0000 0001 0526 7079, GRID grid.1021.2, School of Psychology, , Deakin University, ; Geelong, Australia

[4 ]ISNI 0000000405776836, GRID grid.490467.8, Department of Medicine, , University of Melbourne and Western Health, Sunshine Hospital, ; Melbourne, Australia

[5 ]ISNI 0000 0004 1936 7857, GRID grid.1002.3, Monash University, ; Melbourne, Australia

[6 ]ISNI 0000 0004 0486 528X, GRID grid.1007.6, Dementia Training Australia, , University of Wollongong, ; Melbourne, NSW Australia

[7 ]ISNI 0000 0001 2194 1270, GRID grid.411958.0, School of Allied Health, , Australian Catholic University, ; Sydney, Australia

[8 ]Cairnmillar Institute, Melbourne, Australia

Author information

Marita P. McCabe http://orcid.org/0000-0002-4989-8582

Article

Publisher ID: 966

DOI: 10.1186/s12877-018-0966-1

PMC ID: 6251149

PubMed ID: 30470201

SO-VID: fd496943-4140-42d2-b18a-a4f7446018bd

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 5 June 2018

Date accepted : 25 October 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100000925, National Health and Medical Research Council;

Award ID: APP1142442

Custom metadata

ScienceOpen disciplines: Geriatric medicine

Keywords: consumer directed care,staff training,resident quality of life,residential aged care,resident choice and control

Data availability:

ScienceOpen disciplines: Geriatric medicine

Keywords: consumer directed care, staff training, resident quality of life, residential aged care, resident choice and control

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A randomized controlled trial to evaluate the effectiveness of a staff training program to implement consumer directed care on resident quality of life in residential aged care

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Abstract

Background

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Hearing Loss and Restoration

Most cited references 22

Readiness for Organizational Change: The Systematic Development of a Scale

Motivational predictors of weight loss and weight-loss maintenance.

Residents' experiences of interpersonal factors in nursing home care: a qualitative study.

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