Implementation of Resident-Centered Caregiving in Long Term Care with an Embedded Mentoring Program

Barbara J. Bowers, PhD, RN, FAAN

The purpose of the proposed pilot/feasibility study is to test two components of an intervention study that will be submitted to either NINR, NIA or AHRQ in the fall of 2006. The intervention study will test the implementation of grounded theory of Resident-Centered Caregiving in Long Term Care using an Embedded Nurse Mentoring intervention. The proposal submitted here is to compare two methods of data collection for CNAs and to test two strategies for enhancing the retention of nurse mentors in the study.

Despite the extensive federal, state and industry efforts to improve the quality of long term care, available evidence suggests that very little improvement has been achieved over the past decade and that care quality continues to be substandard in many US nursing homes. Current strategies to correct the situation, sponsored by both government and industry, are moving towards minimizing the role of the nurse in planning, delivering and/or evaluating care practices, moving informal caregivers to a more central place.

Based on 20 years of research in long term care, and integrating empirical research conducted by many other researchers, the PI has developed a grounded theory of caregiving in long term care. This theory was developed to explain fluctuations in the quality of long term care and to guide efforts to improve the quality of care. This research also suggests that maintaining care quality requires closer and more intense, not more distant, involvement of long term care nurses. The theory developed by the PI is based on research suggesting that nurses play an important role in the achievement of care quality only if they are highly integrated into (embedded in) the planning, decision making and evaluation of care. The same research suggests that on-site mentoring is much more effective than traditional forms of staff development.

This pilot/feasibility will compare two methods of collecting data from CNAs about the way they think about and provide care to residents, and the role the nurse plays in the care they deliver. The pilot also compares the attrition rates of nurses in the study using two methods to support/encourage retention and one group with no support. Finally, in addition to the past focus on care quality, this pilot will add an explicit resident-centered dimension to the proposed intervention study planned for later this year.