DSpace Repository :: Browsing by Author "Hartmann, Christine W."

Browsing by Author "Hartmann, Christine W."

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Adaptation of a Nursing Home Culture Change Research Instrument for Frontline Staff Quality Improvement Use
(American Psychological Association, 2017) Hartmann, Christine W.; Palmer, Jennifer A.; Mills, Whitney L.; Pimentel, Camilla B.; Allen, Rebecca S.; Wewiorski, Nancy J.; Dillon, Kristen R.; Snow, A. Lynn; Boston University; Baylor College of Medicine; University of Massachusetts Amherst; University of Alabama Tuscaloosa
Enhanced interpersonal relationships and meaningful resident engagement in daily life are central to nursing home cultural transformation, yet these critical components of person-centered care may be difficult for frontline staff to measure using traditional research instruments. To address the need for easy-to-use instruments to help nursing home staff members evaluate and improve person-centered care, the psychometric method of cognitive-based interviewing was used to adapt a structured observation instrument originally developed for researchers and nursing home surveyors. Twenty-eight staff members from 2 Veterans Health Administration (VHA) nursing homes participated in 1 of 3 rounds of cognitive-based interviews, using the instrument in real-life situations. Modifications to the original instrument were guided by a cognitive processing model of instrument refinement. Following 2 rounds of cognitive interviews, pretesting of the revised instrument, and another round of cognitive interviews, the resulting set of 3 short instruments mirrored the concepts of the original longer instrument but were significantly easier for frontline staff to understand and use. Final results indicated frontline staff found the revised instruments feasible to use and clinically relevant in measuring and improving the lived experience of a changing culture. This article provides a framework for developing or adapting other measurement tools for frontline culture change efforts in nursing homes, in addition to reporting on a practical set of instruments to measure aspects of person-centered care.
Applying a Theory-Driven Framework to Guide Quality Improvement Efforts in Nursing Homes: The LOCK Model
(Oxford University Press, 2018) Mills, Whitney L.; Pimentel, Camilla B.; Palmer, Jennifer A.; Snow, A. Lynn; Wewiorski, Nancy J.; Allen, Rebecca S.; Hartmann, Christine W.; Baylor College of Medicine; University of Massachusetts Worcester; University of Alabama Tuscaloosa; Boston University
Purpose of the Study: Implementing quality improvement (QI) programs in nursing homes continues to encounter significant challenges, despite recognized need. QI approaches provide nursing home staff with opportunities to collaborate on developing and testing strategies for improving care delivery. We present a theory-driven and user-friendly adaptable framework and facilitation package to overcome existing challenges and guide QI efforts in nursing homes. Design and development: The framework is grounded in the foundational concepts of strengths-based learning, observation, relationship-based teams, efficiency, and organizational learning. We adapted these concepts to QI in the nursing home setting, creating the "LOCK" framework. The LOCK framework is currently being disseminated across the Veterans Health Administration. Results: The LOCK framework has five tenets: (a) Look for the bright spots, (b) Observe, (c) Collaborate in huddles, (d) Keep it bite-sized, and (e) facilitation. Each tenet is described. We also present a case study documenting how a fictional nursing home can implement the LOCK framework as part of a QI effort to improve engagement between staff and residents. The case study describes sample observations, processes, and outcomes. We also discuss practical applications for nursing home staff, the adaptability of LOCK for different QI projects, the specific role of facilitation, and lessons learned. Implications: The proposed framework complements national efforts to improve quality of care and quality of life for nursing home residents and may be valuable across long-term care settings and QI project types.
Blended Facilitation as an Effective Implementation Strategy for Quality Improvement and Research in Nursing Homes
(Lippincott Williams & Wilkins, 2019) Pimentel, Camilla B.; Mills, Whitney L.; Palmer, Jennifer A.; Dillon, Kristen; Sullivan, Jennifer L.; Wewiorski, Nancy J.; Snow, Andrea Lynn; Allen, Rebecca S.; Hopkins, Susan D.; Hartmann, Christine W.; Geriatric Research Education & Clinical Center; University of Massachusetts Worcester; US Department of Veterans Affairs; Veterans Health Administration (VHA); Providence VA Medical Center; Harvard University; Hebrew SeniorLife; VA Boston Healthcare System; Boston University; University of Alabama Tuscaloosa
Background: Blended facilitation, which leverages the complementary skills and expertise of external and internal facilitators, is a powerful strategy that nursing stakeholders and researchers may use to improve implementation of quality improvement (QI) innovations and research performed in nursing homes. Problem: Nursing homes present myriad challenges (eg, time constraints, top-down flow of communication, high staff turnover) to QI implementation and research. Approach: This methods article describes the theory and practical application of blended facilitation and its components (external facilitation, internal facilitation, relationship building, and skill building), using examples from a mixed QI and research intervention in Veterans Health Administration nursing homes. Conclusions: Blended facilitation invites nursing home stakeholders to be equal partners in QI and research processes. Its intentional use may overcome many existing barriers to QI and research performed in nursing homes and, by strengthening relationships between researchers and stakeholders, may accelerate implementation of innovative care practices.
A conceptual model for culture change evaluation in nursing homes
(Elsevier, 2013) Hartmann, Christine W.; Snow, A. Lynn; Allen, Rebecca S.; Parmelee, Patricia A.; Palmer, Jennifer A.; Berlowitz, Dan; Boston University; University of Alabama Tuscaloosa
This article describes the development and particulars of a new, comprehensive model of nursing home culture change, the Nursing Home Integrated Model for Producing and Assessing Cultural Transformation (Nursing Home IMPACT). This model is structured into four categories, "meta constructs," "care practices," "workplace practices," and "environment of care," with multiple domains under each. It includes detailed, triangulated assessment methods capturing various stakeholder perspectives for each of the model's domains. It is hoped that this model will serve two functions: first, to help practitioners guide improvements in resident care by identifying particular areas in which culture change is having positive effects, as well as areas that could benefit from modification; and second, to emphasize the importance in culture change of the innumerable perspectives of residents, family members, staff, management, and leadership. Published by Mosby, Inc.
Developing the Supporting Choice Observational Tool (SCOT) A Formative Assessment Tool to Assist Nursing Home Staff in Realizing Resident Choice
(Slack, 2017) Palmer, Jennifer A.; Parker, Victoria A.; Burgess, James F.; Berlowitz, Dan; Snow, A. Lynn; Mitchell, Susan L.; Hartmann, Christine W.; Harvard University; Hebrew SeniorLife; Boston University; Harvard Medical School; University of Alabama Tuscaloosa
Quality of care in nursing homes has begun to address the importance of resident choice in daily life, yet there are no published tools to teach nursing home staff how to offer such choice. In the current study, a formative assessment tool was developed that can provide staff with detailed and concrete feedback on how to realize resident choice. The tool was created and refined through 22 hours of ethnographic observation in two Veterans Health Administration Community Living Centers (CLCs), 22 hours of developmental testing in two CLCs, review by a modified Delphi panel, and use of an algorithm to assess its logical structure. The resulting Supporting Choice Observational Tool (SCOT) documents how choice is or is not offered and is or is not enabled within a singular staff-resident interaction. SCOT findings could be used in clinical teaching, quality improvement, or research efforts intent on enhancing nursing home resident quality of life.
Development of a New Tool for Systematic Observation of Nursing Home Resident and Staff Engagement and Relationship
(Oxford University Press, 2018) Snow, A. Lynn; Jacobs, M. Lindsey; Palmer, Jennifer A.; Parmelee, Patricia A.; Allen, Rebecca S.; Wewiorski, Nancy J.; Hilgeman, Michelle M.; Vinson, Latrice D.; Berlowitz, Dan R.; Halli-Tierney, Anne D.; Hartmann, Christine W.; University of Alabama Tuscaloosa; Boston University
Purpose of Study: To develop a structured observational tool, the Resident-centered Assessment of Interactions with Staff and Engagement tool (RAISE), to measure 2 critical, multi-faceted, organizational-level aspects of person-centered care (PCC) in nursing homes: (a) resident engagement and (b) the quality and frequency of staff-resident interactions. Design and Methods: In this multi-method psychometric development study, we conducted (a) 120 hr of ethnographic observations in one nursing home and (b) a targeted literature review to enable construct development. Two constructs for which no current structured observation measures existed emerged from this phase: nursing home resident-staff engagement and interaction. We developed the preliminary RAISE to measure these constructs and used the tool in 8 nursing homes at an average of 16 times. We conducted 8 iterative psychometric testing and refinement cycles with multi-disciplinary research team members. Each cycle consisted of observations using the draft tool, results review, and tool modification. Results: The final RAISE included a set of coding rules and procedures enabling simultaneously efficient, non-reactive, and representative quantitative measurement of the interaction and engagement components of nursing home life for staff and residents. It comprised 8 observational variables, each represented by extensive numeric codes. Raters achieved adequate to high reliability with all variables. There is preliminary evidence of face and construct validity via expert panel review. Implications: The RAISE represents a valuable step forward in the measurement of PCC, providing objective, reliable data based on systematic observation.
Enhancing sleep quality for nursing home residents with dementia: a pragmatic randomized controlled trial of an evidence-based frontline huddling program
(BMC, 2021) Snow, A. Lynn; Loup, Julia; Morgan, Robert O.; Richards, Kathy; Parmelee, Patricia A.; Baier, Rosa R.; McCreedy, Ellen; Frank, Barbara; Brady, Cathie; Fry, Liam; McCullough, Megan; Hartmann, Christine W.; University of Alabama Tuscaloosa; University of Texas Health Science Center Houston; University of Texas School Public Health; University of Texas Austin; Brown University; University of Massachusetts Lowell
Background: Disturbed sleep places older adults at higher risk for frailty, morbidity, and even mortality. Yet, nursing home routines frequently disturb residents' sleep through use of noise, light, or efforts to reduce incontinence. Nursing home residents with Alzheimer's disease and or related dementias-almost two-thirds of long-stay nursing home residents-are likely to be particularly affected by sleep disturbance. Addressing these issues, this study protocol implements an evidence-based intervention to improve sleep: a nursing home frontline staff huddling program known as LOCK. The LOCK program is derived from evidence supporting strengths-based learning, systematic observation, relationship-based teamwork, and efficiency. Methods: This study protocol outlines a NIH Stage III, real-world hybrid efficacy-effectiveness pragmatic trial of the LOCK sleep intervention. Over two phases, in a total of 27 non-VA nursing homes from 3 corporations, the study will (1) refine the LOCK program to focus on sleep for residents with dementia, (2) test the impact of the LOCK sleep intervention for nursing home residents with dementia, and (3) evaluate the intervention's sustainability. Phase 1 (1 year; n = 3 nursing homes; 1 per corporation) will refine the intervention and train-the-trainer protocol and pilot-tests all study methods. Phase 2 (4 years; n = 24 nursing homes; 8 per corporation) will use the refined intervention to conduct a wedge-design randomized, controlled, clinical trial. Phase 2 results will measure the LOCK sleep intervention's impact on sleep (primary outcome) and on psychotropic medication use, pain and analgesic medication use, and activities of daily living decline (secondary outcomes). Findings will point to inter-facility variation in the program's implementation and sustainability. Discussion: This is the first study to our knowledge that applies a dementia sleep intervention to systematically address known barriers to nursing home quality improvement efforts. This innovative study has future potential to address clinical issues beyond sleep (safety, infection control) and expand to other settings (assisted living, inpatient mental health). The study's strong team, careful consideration of design challenges, and resulting rigorous, pragmatic approach will ensure success of this promising intervention for nursing home residents with dementia.
Huddles and their effectiveness at the frontlines of clinical care: a scoping review
(Springer, 2021) Pimentel, Camilla B.; Snow, A. Lynn; Carnes, Sarah L.; Shah, Nishant R.; Loup, Julia R.; Vallejo-Luces, Tatiana M.; Madrigal, Caroline; Hartmann, Christine W.; Geriatric Research Education & Clinical Center; University of Massachusetts Worcester; University of Alabama Tuscaloosa; Brown University; University of Florida; US Department of Veterans Affairs; Veterans Health Administration (VHA); Providence VA Medical Center; University of Massachusetts Lowell
BACKGROUND: Brief, stand-up meetings known as huddles may improve clinical care, but knowledge about huddle implementation and effectiveness at the frontlines is fragmented and setting specific. This work provides a comprehensive overview of huddles used in diverse health care settings, examines the empirical support for huddle effectiveness, and identifies knowledge gaps and opportunities for future research. METHODS: A scoping review was completed by searching the databases PubMed, EBSCOhost, ProQuest, and OvidSP for studies published in English from inception to May 31, 2019. Eligible studies described huddles that (1) took place in a clinical or medical setting providing health care patient services, (2) included frontline staff members, (3) were used to improve care quality, and (4) were studied empirically. Two reviewers independently screened abstracts and full texts; seven reviewers independently abstracted data from full texts. RESULTS: Of 2,185 identified studies, 158 met inclusion criteria. The majority (67.7%) of studies described huddles used to improve team communication, collaboration, and/or coordination. Huddles positively impacted team process outcomes in 67.7% of studies, including improvements in efficiency, process-based functioning, and communication across clinical roles (64.4%); situational awareness and staff perceptions of safety and safety climate (44.6%); and staff satisfaction and engagement (29.7%). Almost half of studies (44.3%) reported huddles positively impacting clinical care outcomes such as patients receiving timely and/or evidence-based assessments and care (31.4%); decreased medical errors and adverse drug events (24.3%); and decreased rates of other negative outcomes (20.0%). DISCUSSION: Huddles involving frontline staff are an increasingly prevalent practice across diverse health care settings. Huddles are generally interdisciplinary and aimed at improving team communication, collaboration, and/or coordination. Data from the scoping review point to the effectiveness of huddles at improving work and team process outcomes and indicate the positive impact of huddles can extend beyond processes to include improvements in clinical outcomes.
Impact of Intervention to Improve Nursing Home Resident-Staff Interactions and Engagement
(Oxford University Press, 2018) Hartmann, Christine W.; Mills, Whitney L.; Pimentel, Camilla B.; Palmer, Jennifer A.; Allen, Rebecca S.; Zhao, Shibei; Wewiorski, Nancy J.; Sullivan, Jennifer L.; Dillon, Kristen; Clark, Valerie; Berlowitz, Dan R.; Snow, Andrea Lynn; Boston University; Baylor College of Medicine; Geriatric Research Education & Clinical Center; University of Massachusetts Worcester; Harvard University; Hebrew SeniorLife; University of Alabama Tuscaloosa; US Department of Veterans Affairs; Veterans Health Administration (VHA); VA Boston Healthcare System
Background and Objectives: For nursing home residents, positive interactions with staff and engagement in daily life contribute meaningfully to quality of life. We sought to improve these aspects of person-centered care in an opportunistic snowball sample of six Veterans Health Administration nursing homes (e.g., Community Living Centers-CLCs) using an intervention that targeted staff behavior change, focusing on improving interactions between residents and staff and thereby ultimately aiming to improve resident engagement. Research Design and Methods: We grounded this mixed-methods study in the Capability, Opportunity, Motivation, Behavior (COM-B) model of behavior change. We implemented the intervention by (a) using a set of evidence-based practices for implementing quality improvement and (b) combining primarily CLC-based staff facilitation with some researcherled facilitation. Validated resident and staff surveys and structured observations collected pre and post intervention, as well as semi-structured staff interviews conducted post intervention, helped assess intervention success. Results: Sixty-two CLC residents and 308 staff members responded to the surveys. Researchers conducted 1,490 discrete observations. Intervention implementation was associated with increased staff communication with residents during the provision of direct care and decreased negative staff interactions with residents. In the 66 interviews, staff consistently credited the intervention with helping them (a) develop awareness of the importance of identifying opportunities for engagement and (b) act to improve the quality of interactions between residents and staff. Discussion and Implications: The intervention proved feasible and influenced staff to make simple enhancements to their behaviors that improved resident-staff interactions and staff-assessed resident engagement.
The relationship between nursing home quality and costs: Evidence from the VA
(PLOS, 2018) Carey, Kathleen; Zhao, Shibei; Snow, A. Lynn; Hartmann, Christine W.; Boston University; University of Alabama Tuscaloosa
Ensuring quality of care in nursing homes is a public health priority, yet how nursing home quality relates to cost is not well understood. This paper addresses this relationship for 132 VA community living centers (nursing homes), for fiscal years 2014 and 2015. We estimated cost models using the VA Decision Support System which tracks total direct costs and nursing direct costs for individual resident segments of care. We summed residents' total costs and nursing costs to the community living center level for each year. Annual facility costs then were regressed on quality of care measured with composite scores based on 13 distinct adverse events. Results indicated that higher quality was associated with higher predicted cost. However, we did not find evidence that higher costs were driven by high nurse staffing levels.
Resident Choice: A Nursing Home Staff Perspective on Tensions and Resolutions
(Elsevier, 2018) Palmer, Jennifer A.; Parker, Victoria A.; Berlowitz, Dan; Snow, A. Lynn; Hartmann, Christine W.; Boston University; University of Alabama Tuscaloosa
A central component of person-centered care, resident choice in daily life, has received little research attention in the U.S. context. This study investigated nursing home staff experiences in realizing resident choice. Twenty-six qualitative staff interviews were conducted in an opportunistic sample from two Veterans Health Administration (VHA) Community Living Centers (CLCs, i.e., nursing homes) implementing the Green House Model. Thematic content analysis surfaced several key tensions at the intrapersonal, inter-personal, and organizational levels. Most salient were staff mental models within the intrapersonal level. Staff conveyed a lack of clarity on how to realize resident choice when faced with varying tensions, especially the competing goal of resident medical and safety needs. Staff-employed resolutions to resident choice-related tensions also emerged (e.g., preventive practices, staff reinforcement, and staff deliberation). This study offers specific and concrete insights on how resident choice in daily life, and thus resident quality of life, can be advanced. Published by Elsevier Inc.

Browsing by Author "Hartmann, Christine W."

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