title: A Systematic Review of Interventions to Change Staff Care Practices in Order to Improve Resident Outcomes in Nursing Homes.
abstract: BACKGROUND
  We systematically reviewed interventions that attempted to change staff practice to improve long-term care resident outcomes.
  
  
  METHODS
  Studies met criteria if they used a control group, included 6 or more nursing home units and quantitatively assessed staff behavior or resident outcomes. Intervention components were coded as including education material, training, audit and feedback, monitoring, champions, team meetings, policy or procedures and organizational restructure.
  
  
  RESULTS
  Sixty-three unique studies were broadly grouped according to clinical domain-oral health (3 studies), hygiene and infection control (3 studies), nutrition (2 studies), nursing home acquired pneumonia (2 studies), depression (2 studies) appropriate prescribing (7 studies), reduction of physical restraints (3 studies), management of behavioral and psychological symptoms of dementia (6 studies), falls reduction and prevention (11 studies), quality improvement (9 studies), philosophy of care (10 studies) and other (5 studies). No single intervention component, combination of, or increased number of components was associated with greater likelihood of positive outcomes. Studies with positive outcomes for residents also tended to change staff behavior, however changing staff behavior did not necessarily improve resident outcomes. Studies targeting specific care tasks (e.g. oral care, physical restraints) were more likely to produce positive outcomes than those requiring global practice changes (e.g. care philosophy). Studies using intervention theories were more likely to be successful. Program logic was rarely articulated, so it was often unclear whether there was a coherent connection between the intervention components and measured outcomes. Many studies reported barriers relating to staff (e.g. turnover, high workload, attitudes) or organizational factors (e.g. funding, resources, logistics).
  
  
  CONCLUSIONS
  Changing staff practice in nursing homes is possible but complex. Interventionists should consider barriers and feasibility of program components to impact on each intended outcome.
authors.affiliation: Faculty of Health Sciences, University of Sydney, New South Wales, Australia.
authors.forename: Lee-Fay
authors.initials: LF
authors.lastname: Low
authors.affiliation: Faculty of Health Sciences, University of Sydney, New South Wales, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Fletcher
authors.affiliation: Dementia Collaborative Research Centre: Assessment and Better Care, University of New South Wales, New South Wales, Australia.|Dementia Study Training Centre, University of Wollongong, New South Wales, Australia.
authors.forename: Belinda
authors.initials: B
authors.lastname: Goodenough
authors.affiliation: Sydney Nursing School, University of Sydney, New South Wales, Australia.
authors.forename: Yun-Hee
authors.initials: YH
authors.lastname: Jeon
authors.affiliation: School of Medicine and Pharmacology Royal Perth Hospital Unit, The University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Etherton-Beer
authors.affiliation: Dementia Collaborative Research Centre: Carers and Consumers, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: MacAndrew
authors.affiliation: Dementia Collaborative Research Centre: Carers and Consumers, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Beattie
mesh_terms: D006801:Humans; D009735:Nursing Homes; D009740:Nursing Staff; D017063:Outcome Assessment, Health Care; D057184:Practice Patterns, Nurses'