title: Identifying resident care areas for a quality improvement intervention in long-term care: a collaborative approach.
abstract: BACKGROUND
  In Canada, healthcare aides (also referred to as nurse aides, personal support workers, nursing assistants) are unregulated personnel who provide 70-80% of direct care to residents living in nursing homes. Although they are an integral part of the care team their contributions to the resident care planning process are not always acknowledged in the organization. The purpose of the Safer Care for Older Persons [in residential] Environments (SCOPE) project was to evaluate the feasibility of engaging front line staff (primarily healthcare aides) to use quality improvement methods to integrate best practices into resident care. This paper describes the process used by teams participating in the SCOPE project to select clinical improvement areas.
  
  
  METHODS
  The study employed a collaborative approach to identify clinical areas and through consensus, teams selected one of three areas. To select the clinical areas we recruited two nursing homes not involved in the SCOPE project and sampled healthcare providers and decision-makers within them. A vote counting method was used to determine the top five ranked clinical areas for improvement.
  
  
  RESULTS
  Responses received from stakeholder groups included gerontology experts, decision-makers, registered nurses, managers, and healthcare aides. The top ranked areas from highest to lowest were pain/discomfort management, behaviour management, depression, skin integrity, and assistance with eating.
  
  
  CONCLUSIONS
  Involving staff in selecting areas that they perceive as needing improvement may facilitate staff engagement in the quality improvement process.
authors.affiliation: Faculty of Nursing, University of Alberta, Level 3 Edmonton Clinic Health Academy, 11405 87 Avenue, Alberta, Edmonton T6G 1C9, Canada. cranley@ualberta.ca
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Cranley
authors.forename: Peter G
authors.initials: PG
authors.lastname: Norton
authors.forename: Greta G
authors.initials: GG
authors.lastname: Cummings
authors.forename: Debbie
authors.initials: D
authors.lastname: Barnard
authors.forename: Neha
authors.initials: N
authors.lastname: Batra-Garga
authors.forename: Carole A
authors.initials: CA
authors.lastname: Estabrooks
mesh_terms: D003299:Cooperative Behavior; D006801:Humans; D008134:Long-Term Care / Q000379:methods / Q000592:standards; D009728:Nursing Assistants / Q000592:standards*; D009735:Nursing Homes / Q000592:standards*; D010348:Patient Care Team / Q000592:standards*; D058996:Quality Improvement / Q000592:standards*