Managing the deteriorating nursing home resident after the introduction of a hospital avoidance programme: a nursing perspective

BACKGROUND Hospital avoidance programmes aim to reduce the number of emergency transfers from nursing homes to hospitals and facilitate early discharge for hospitalised residents. Nursing staff are at the forefront of these efforts, yet little is known about how the programmes affect them and their management of the deteriorating resident. This information is needed to inform hospital avoidance programmes and better understand their work. AIM To examine nursing home nursing staff perceptions regarding their management of the deteriorating resident after the introduction of a hospital avoidance programme. METHODS A thematic analysis was conducted of focus group data collected from nursing staff 14 to 15 months after the introduction of a pilot hospital avoidance programme at an Australian nursing home. FINDINGS The programme was well received and filled a gap in nursing staff management of residents with deteriorating health by providing structure and support. Staff were more confident and focused on this area of their work. Nursing assistants felt more integrated into the system and were supported and learning from nurses. Workload remained heavy and there was a shift in how time was allocated, but nursing staff preferred to keep residents at the facility. CONCLUSION Nursing staff welcomed the programme and benefitted from its implementation. However, strategies must be explored to accommodate the staffing needs associated with providing emergency and subacute care in the nursing home setting.

[1]  B. O'Neill,et al.  Nursing home nurses' perceptions of emergency transfers from nursing homes to hospital: A review of qualitative studies using systematic methods. , 2015, Geriatric nursing.

[2]  E. Burkett,et al.  CARE-PACT: a new paradigm of care for acutely unwell residents 
in aged care facilities. , 2015, Australian family physician.

[3]  L. Perry,et al.  Clinical user experiences of observation and response charts: focus group findings of using a new format chart incorporating a track and trigger system , 2014, BMJ quality & safety.

[4]  L. Aitken,et al.  Nurses' perceptions of accessing a Medical Emergency Team: a qualitative study. , 2014, Australian critical care : official journal of the Confederation of Australian Critical Care Nurses.

[5]  Alyce S. Ashcraft,et al.  From nursing home to acute care: signs, symptoms, and strategies used to prevent transfer. , 2014, Geriatric nursing.

[6]  R. Nay,et al.  Decision to transfer to hospital from the residential aged care setting: a systematic review of qualitative evidence exploring residential aged care staff experiences , 2014 .

[7]  J. Ouslander,et al.  The Interventions to Reduce Acute Care Transfers (INTERACT) quality improvement program: an overview for medical directors and primary care clinicians in long term care. , 2014, Journal of the American Medical Directors Association.

[8]  S. Mackey,et al.  Front line nurses' experiences with deteriorating ward patients: a qualitative study. , 2013, International nursing review.

[9]  N. Zhang,et al.  Gaps in nurse staffng and nursing home resident needs. , 2013, Nursing economic$.

[10]  J. Considine,et al.  Referrals to hospital emergency departments from residential aged care facilities: Stuck in a time warp , 2013, Contemporary nurse.

[11]  K. Howard,et al.  Decision to transfer to an emergency department from residential aged care: A systematic review of qualitative research , 2013, Geriatrics & gerontology international.

[12]  D. O’Neill,et al.  Nursing home residents attending the emergency department: clinical characteristics and outcomes. , 2013, QJM : monthly journal of the Association of Physicians.

[13]  W. Wodchis,et al.  Determinants of regulated nurses' intention to stay in long-term care homes. , 2013, Journal of nursing management.

[14]  Marie P Boltz,et al.  Examining the feasibility and utility of an SBAR protocol in long-term care. , 2013, Geriatric nursing.

[15]  B. Wadensten,et al.  Communication and coordination during transition of older persons between nursing homes and hospital still in need of improvement. , 2013, Journal of advanced nursing.

[16]  Clinical decision-making process for early nonspecific signs of infection in institutionalised elderly persons: experience of nursing assistants. , 2013, Scandinavian journal of caring sciences.

[17]  Ann McDonnell,et al.  A before and after study assessing the impact of a new model for recognizing and responding to early signs of deterioration in an acute hospital. , 2013, Journal of advanced nursing.

[18]  J. Ouslander,et al.  Geriatrics and the Triple Aim: Defining Preventable Hospitalizations in the Long‐Term Care Population , 2012, Journal of the American Geriatrics Society.

[19]  Serena Barello,et al.  Patient Engagement as an Emerging Challenge for Healthcare Services: Mapping the Literature , 2012, Nursing research and practice.

[20]  Alyce S. Ashcraft,et al.  Nursing Home Resident Symptomatology Triggering Transfer: Avoiding Unnecessary Hospitalizations , 2012, Nursing research and practice.

[21]  J. Ouslander,et al.  Reducing potentially preventable hospital transfers: results from a thirty nursing home collaborative. , 2012, Journal of the American Medical Directors Association.

[22]  Ivana Acocella.  The focus groups in social research: advantages and disadvantages , 2012 .

[23]  Joshua Healy,et al.  The aged care workforce 2012: final report , 2012 .

[24]  M. Wallis,et al.  A structure and process evaluation of an Australian hospital admission avoidance programme for aged care facility residents. , 2012, Journal of advanced nursing.

[25]  E. Whitmore,et al.  Decisions about transferring nursing home residents to hospital: highlighting the roles of advance care planning and support from local hospital and community health services. , 2011, Journal of clinical nursing.

[26]  J. Ouslander,et al.  Avoidability of Hospital Transfers of Nursing Home Residents: Perspectives of Frontline Staff , 2011, Journal of the American Geriatrics Society.

[27]  D. Polit,et al.  An outcomes evaluation of an Australian Hospital in the Nursing Home admission avoidance programme. , 2011, Journal of clinical nursing.

[28]  Alice Bonner,et al.  Interventions to Reduce Hospitalizations from Nursing Homes: Evaluation of the INTERACT II Collaborative Quality Improvement Project , 2011, Journal of the American Geriatrics Society.

[29]  Helen Cox,et al.  Vital signs for vital people: an exploratory study into the role of the Healthcare Assistant in recognising, recording and responding to the acutely ill patient in the general ward setting. , 2010, Journal of nursing management.

[30]  K. Howard,et al.  The interface between residential aged care and the emergency department: a systematic review. , 2010, Age and ageing.

[31]  J. Wyman,et al.  Preventing Avoidable Hospitalizations of Nursing Home Residents: A Multipronged Approach to a Perennial Problem , 2010, Journal of the American Geriatrics Society.

[32]  A. Atherly,et al.  Potentially Avoidable Hospitalizations of Nursing Home Residents: Frequency, Causes, and Costs , 2010, Journal of the American Geriatrics Society.

[33]  L. Kluge,et al.  Reducing potentially avoidable hospitalizations of nursing home residents: results of a pilot quality improvement project. , 2009, Journal of the American Medical Directors Association.

[34]  Lisa Byrd.  Reducing avoidable hospitalizations in nursing could save $1 billion annually--so why delay? , 2009, Geriatric nursing.

[35]  A. Szczepura,et al.  The forgotten sector: workforce development in residential care for older people , 2009 .

[36]  A. Szczepura,et al.  In-reach specialist nursing teams for residential care homes: uptake of services, impact on care provision and cost-effectiveness , 2008, BMC health services research.

[37]  Resident condition change: should I call 911? , 2008, Geriatric nursing.

[38]  Juliet M. Corbin,et al.  Basics of Qualitative Research (3rd ed.): Techniques and Procedures for Developing Grounded Theory , 2008 .

[39]  R. Jablonski,et al.  Decisions about transfer from nursing home to emergency department. , 2007, Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing.

[40]  Ruth A. Anderson,et al.  Barriers to and Facilitators of Clinical Practice Guideline Use in Nursing Homes , 2007, Journal of the American Geriatrics Society.

[41]  Marie F. Shoffner,et al.  Focus Groups: A Practical and Applied Research Approach for Counselors , 2007 .

[42]  K. Grimmer-Somers,et al.  A synthesis of the secondary literature on effectiveness of hospital avoidance and discharge programs. , 2007, Australian health review : a publication of the Australian Hospital Association.

[43]  Stella Chan,et al.  Advance care planning and hospital in the nursing home. , 2006, Age and ageing.

[44]  M. Loeb,et al.  A clinical pathway for treating pneumonia in the nursing home: part I: the nursing perspective. , 2006, Journal of the American Medical Directors Association.

[45]  E. Marcantonio,et al.  Nursing Home Capabilities and Decisions to Hospitalize: A Survey of Medical Directors and Directors of Nursing , 2006, Journal of the American Geriatrics Society.

[46]  V. Braun,et al.  Using thematic analysis in psychology , 2006 .

[47]  S. Zimmerman,et al.  Outcomes of Infection in Nursing Home Residents with and without Early Hospital Transfer , 2005, Journal of the American Geriatrics Society.

[48]  B. Lundman,et al.  Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. , 2004, Nurse education today.

[49]  Anselm L. Strauss,et al.  Basics of qualitative research : techniques and procedures for developing grounded theory , 1998 .

[50]  M. Creditor.  Hazards of Hospitalization of the Elderly , 1993, Annals of Internal Medicine.