Critical Appraisal Of Systematic Reviews On Implementation Of Good Practices In Clinical Practice And Behaviour Of Nursing Staffs In Residential Care Homes

PICO question

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).

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:

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 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.

Literature review

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 program logic models. Data was analysed and results were represented in tabular form. Risk of bias has been eliminated by using the Cochrane Risk of Bias for EPOC reviews tool that helps to identify the bias in performance, selection, reporting, detection and others (Low et al., 2015).

The researchers have identified 7572 articles from which 211 articles were obtained that contained full text. Among the full text articles only 77 articles have been found that have fulfilled the inclusion criteria. In addition 2 articles were identified through the hand searching reference. Therefore total 79 articles were selected including unique research in order to obtain the desired result. 3 studies have examined the effectiveness of interventions related to the staffs of oral residential care. 2 studies have inquired similar groups and represented identical result as well. One study has provided information regarding the training and using tooth brush as the interventions in order to improve the residential oral care. However, none of them have identified the association of behaviour change with the interventions, but reported the enhancement in the oral health. 2 studies have been selected that have identified the impact of different interventions on the infection control and hygiene factors. Intervention includes training associated with additional strategies. Both the studies have reported regarding the improvement in the behaviour of the staffs related to hygiene maintenance and infection control and positive changes in the health care staffs has led to the consequence of improved health outcomes such as reduction in hospitalization, infection, respiratory problems and other health issues (Low et al., 2015).

2 studies have been found that have focused on nutrition. Both of the studies have supported the education and training program in order to introduce change in the behaviour of the staffs and improvement in the indicators of nutrients as well. Pneumonia acquired from the nursing home has been chosen by 2 studies as the field of experiment. The studies have identified nurse training program and vaccination of the staffs as the interventions. However, difference in the outcomes has not been found. Depression related studies have been chosen by the researchers for the systematic review. The studies have indicated training as the intervention but association with staff outcomes has not been identified in the studies. 7 studies have been chosen that have provided information regarding the proper medication. It has been found that providing education to the health care staffs could reduce the medication error and improve the patient outcomes. Other interventions included feedback process, meetings within the health care team and audit. However, the studies did not measure the effect of the interventions on the behaviour of the staffs. Behaviour management and psychological symptoms during dementia have been studied by 6 studies. Interventions provided by the study include training, mentoring, using reminders and providing support. However, only 2 studies have indicated the relation of interventions with change in behaviour of the staffs. 11 studies related to fall prevention were also included that, among which only 5 studies have indicated impact of interventions on the staff’s behaviour (Low et al., 2015).

9 studies have been introduced to inquire the effectiveness of interventions in order to enhance the care quality. One study has been identified the association of staff behaviour with interventions and indicated the effectiveness of the interventions in order to improve the health service and achieve expected health outcomes. Philosophy of care has been considered in 10 studies and only 7 studies indicated change in the behaviour of the staffs but with least improvement. Other domains in the clinical practice have shown positive outcomes. In addition 3 studies have been introduced associated with program logic. The studies have shown that the changes in the staff practice have not evaluated properly and only several aspects were evaluated. The evidences did not provide strong logical link between interventions and staff behaviour. 3 studies have indicated that implementing program for the clinicians could be helpful to improve the behaviour of the staffs and introduce good practice. Some studies have helped to find out the barriers such as absenteeism, high employee turnover, excessive work pressure, lack of communication, lack of funding and lack of education. The care service provided by the staffs, needs of the residents and attitudes of their families could act as the facilitators to introduce good practice and change the behaviour of the staffs to enhance the quality of service. With such result the researchers have concluded that adequate contemplating programs are needed to improve the behaviour of the health care staffs and multidimensional interventions are needed. In addition further studies need to be introduced to evaluate sustaining behaviour of the clinical staffs (Low et al., 2015).

In order to review the evidence and quality of the systematic review the CASP checklist has been used for critical appraisal. The tool is effective as it helps to evaluate the quality of systematic review through relevant questions that could help to identify the level of evidence, quality of result and level of generalizability of the findings in order to evaluate the overall quality of the paper (casp-uk.net, 2018).

CASP checklist for systematic review:

Conclusion:

From the above discussion it can be said that, effective interventions need to apply in order to introduce good practice in the residential care or hospital settings. It is important to introduce good practice as it helps the nursing staffs to change their behaviour and adapt healthy behaviour and help the hospitals and residential care home to change culture in an effective manner. Such changes could help to improve the care service and achieve positive health outcomes. However, some studies have indicated that there is no relation between good practice and changing behaviour, but most of the studies included in the systematic review have indicated association of good practice and changing behaviour. Thus, further study is required to elaborate the fact in an effective manner,

References:

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