title: Care Plan Improvement in Nursing Homes: An Integrative Review.
abstract: Care planning nowadays is a key activity in the provision of services to nursing home residents. A care plan describes the residents' needs and the actions to address them, providing both individualized and standardized interventions and should be updated as changes in the residents' conditions occur.
  
  
  
  The aim of this review was to identify the core elements of the implementation of changes in nursing homes' care plans, by providing an overview of the type of stakeholders involved, describing the implementation strategies used, and exploring how care plans changed.
  
  
  
  An integrative literature review was used to evaluate intervention studies taking place in nursing homes. Data were collected from PubMed, CINHAL-EBSCO, and PsycINFO. English language articles published between 1995 and April 2015 were included. Data analysis followed the strategy of Knafl and Whittemore.
  
  
  
  Twenty-six articles were included. The stakeholders involved were professionals, family caregivers, and patients. Only a few studies directly involved residents and family caregivers in the quality improvement process. The implementation strategies used were technology implementation, audit, training, feedback, and supervision. The majority of interventions changed the residents' care plans in terms of developing a more standardized care documentation that primarily focuses on its quality. Only some interventions developed more tailored care plans that focus on individualized needs.
  
  
  
  Care plans generally failed in providing both standardized and personalized interventions. Efforts should be made to directly involve residents in care planning and provide professionals with efficient tools to report care goals and actions in care plans.
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands.|Department of Psychology, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Mariani
authors.affiliation: Department of Psychology, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
authors.forename: Rabih
authors.initials: R
authors.lastname: Chattat
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands.|Kalorama Foundation, Beek-Ubbergen, The Netherlands.|Radboud Alzheimer Center, Nijmegen, The Netherlands.
authors.forename: Myrra
authors.initials: M
authors.lastname: Vernooij-Dassen
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.|Joachim & Anna, Center for Specialized Geriatric Care, Nijmegen, The Netherlands.|Radboud Alzheimer Center, Nijmegen, The Netherlands.
authors.forename: Raymond
authors.initials: R
authors.lastname: Koopmans
authors.affiliation: Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Engels
mesh_terms: D017028:Caregivers / Q000523:psychology; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D006801:Humans; D009723:Nurse-Patient Relations; D009735:Nursing Homes; D009740:Nursing Staff; D010347:Patient Care Planning / Q000706:statistics & numerical data; D015397:Program Evaluation
keywords: Care plan; elderly residents; implementation; nursing documentation; nursing homes; quality improvement; stakeholders