title: Resident-directed long-term care: staff provision of choice during morning care.
abstract: OBJECTIVE
  To develop an observational protocol to assess the quality of staff-resident communication relevant to choice and describe staff-resident interactions as preliminary evidence of the usefulness of the tool to assess current nursing home practices related to offering choice during morning care provision.
  
  
  METHODS
  This study included 73 long-stay residents in 2 facilities. Research staff conducted observations for 4 consecutive morning hours during targeted care activities (transfer out of bed, incontinence, dressing, and dining location). Observations were conducted weekly for 12 consecutive weeks. Staff-resident interactions were measured related to staff offers of choice and residents' responses.
  
  
  RESULTS
  Interrater agreement was achieved for measures of staff offers of choice (kappa = .83, p < .001), type of choice provided (kappa = .75, p < .001), and resident requests related to choice (kappa = .72, p < .001). Observations over 2,766 care episodes during 4 aspects of morning care showed that staff offered residents choice during 18% of the episodes. Most observations (70%) were coded as staff offering "no choice."
  
  
  CONCLUSIONS
  Nursing home staff can use a simplified version of this standardized observational tool to reliably measure staff-resident interactions related to choice during morning care provision as a first step toward improving resident-directed care practice.
authors: Division of General Internal Medicine and Public Health, Center for Quality Aging, School of Medicine, Vanderbilt University Medical Center, S-1121, Nashville, TN 37232-2400, USA. sandra.simmons@vanderbilt.edu
authors: Sandra F
authors: SF
authors: Simmons
authors: Annie
authors: A
authors: Rahman
authors: Linda
authors: L
authors: Beuscher
authors: Victoria
authors: V
authors: Jani
authors: Daniel W
authors: DW
authors: Durkin
authors: John F
authors: JF
authors: Schnelle
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002755:Choice Behavior; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D005851:Geriatric Nursing / Q000592:standards*; D006299:Health Services for the Aged / Q000592:standards; D006707:Homes for the Aged / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration*; D008297:Male; D009735:Nursing Homes / Q000458:organization & administration* / Q000592:standards; D011787:Quality of Health Care / Q000592:standards*; D013714:Tennessee