Assessing the Utilization of Nursing Research in Extended Care FacilitiesELLENOR CHANCE RN, BSN, FNP-S

Objectives

Discuss nursing research and evidence based practice.

Discuss the problem with nursing homes and research utilization.

Review research question

Review the literature on the utilization of nursing research in extended care facilities.

Discuss the significance of the literature review

Discuss non-thesis research findings

Discuss future implications

Background

• Scientific process that validates existing knowledge and generates new knowledge.

• Directly and indirectly influences the delivery of evidence based nursing

Nursing Research

• best research evidence to support clinical decision making.

• improve heath outcomes of patients.

Evidence Based Practice

Background

Nursing has become a professional practice with the use of research and Evidence based practice.

Evidence based practice is known to increase quality of care and patient outcomes.

However studies suggest that nurses are not using research at the bedside instead they obtain information from each other.

Background

Rogers Diffusion of Innovation Theory

Background

Barriers to Research Utilization Lack of interest Lack of time Lack authority to change practices Inability to understand research findings Unsupportive organizational climates

Background

Supportive nursing environments focus on activities that develop nursing staff through education and research.

Outcomes

Patient Increase

s

Problem

There is little evidence on the utilization of nursing research in Extended Care Facilities.

Problem

The quality of care in many U.S nursing homes remains less than optimal.

Most notably the presence of pressure ulcers (important indicator of the QUALITY of nursing home care) have increased and now 11% of all nursing home residents have pressure ulcers, of these 76% are stage 2 or higher.

Receive deficiency citations during federally mandated nursing home inspections.

They continue to cycle in and out of deficiency status

No sustained adherence to mandated levels of quality care.

Problem

Over the next 25 years the number of individuals age 65 and older will double.

Elder adult care cost is three to five times higher than young adults.

Medicare spends about $336 million dollars in older adult care annually

Admission rates is expected to rise along with cost by year 2050.

Many elder adults will at some point be faced with the decision to enter nursing homes for care.

Research Question

Are nurses utilizing nursing research and current evidence based practices in extended care facilities?

Literature Review

Literature Review was performed using CINHAL and OVID search engines

key words…Utilization, Research, and Nursing homes

Literature Review consist of 15 scholarly articles.

Reliable sources CDC, Healthy People 2020, and National Nursing Homes Survey were used.

Literature Review

Inappropriate to extrapolate

findings

suboptimal care

No organizational

support

Deficiency citations

Scarce Findings

RECURRING THEMES:

Literature Review

Literature suggests suboptimal care in nursing home residents in the following areas

Increased ED admissions while under nursing home care

Pressure ulcer acquisition while under nursing home care

Literature Review

Falls Poly pharmacyPoor pain management

Literature Review

9%

11%

50%

20%

11%

Deficient Areas

falls

pressure ulcer

poly pharm

pain mgt

ED visits

Literature Review

Shorter hospital stays = Admission of sicker residents Increased functional dependence Co morbid conditions

(NHHS, 2004)

Literature Review

The use of highly technical interventions Only 1.6% of nursing home residents require no

assistance with ADL’s More than half of all nursing home residents require

assistance or are totally dependent with all ADL’s.

Literature Review

5 ADl's; 51.1

4 ADL's; 27.5

3 ADL's; 6.3

2 ADL's; 5.9

No ADL's; 1.6unknown; 1.1

ADL Assistance

5 ADl's

4 ADL's

3 ADL's

2 ADL's

No ADL's

unknown

(NHHS, 2004)

Literature Review

International task force was convened to address the gaps in clinical practice.

Recommendations focused on enhancing the reputation of nursing homes through …. Strengthening leadership, clinical practice, quality of

care, education and RESEARCH

Significance

Important to assess research utilization to ensure that health care providers are meeting Healthy People 2020’s goal of improving the health, function, and quality of life in older adults,

Significance

Nursing home care is reportedly SUBOPTIMAL Nursing environments that place emphasis on

EDUCATION and RESEARCH have positive effects on QUALITY of care and patient outcomes.

***fewer deficiency citations and pressure ulcer acquisition rates are lower.

Significance

INTERACT (Interventions to Reduce Acute Care Transfers)- clinical practice tool that’s used to reduce hospital admission rates.

INTERACT

Communication

Identify Conditions

Evaluate and treat

Documentation Prevent ED admissions

Significance

Registered Nurses Nurse Practitioners

Hospital admission rates

Non-thesis Presentation Findings

Research assessment tool was used to assess a small group of nursing home nurses research utilization and organizational support.

Comfortable with research 60% YES other 40% were NOT SURE

Non-Thesis Presentation Findings

Participated in research projects 40% YES, 60% said NO

Aware of any research being conducted in their work pace-60% NO, 20% yes, 20% NOT SURE

Do you feel that your facility encourages research 40% YES, 40% SOMEWHAT, 20% NO.

Need to assess the utilization of research in extended care facilities 100% YES.

Future Implications

Individuals are living longer with chronic illnesses and co morbidities, and will at some point be faced with a decision to enter into nursing home care.

Suboptimal care puts nursing home residents at risk for pressure ulcers, falls, poly pharmacy, poor pain management, and avoidable hospital admissions, all of which decreases quality of care and increases Medicare and Medicaid spending.

Future Implications

More information is needed on this subset of nurses use of research to decrease the incident of deficiency in areas that indicate quality of care in older adults.

References

Anderson, N., Jylli, L., Kajermo, K. N., & Klang, B. (2007). Nurses in pediatric care-self reported professional and perceived research utilization. Scand Journal of Caring Science, 426-433. Baernholdt, M., & Lang, N. M. (2007). Government chief nursing officers' perceptions of barriers to using research on staffing. International Nursing Review, 54, 49-55. Brown, C. E., Ecoff, L., Kim, S. C., Wickline, M. A., Rose, B., Klimpel, K., & Glaser, D. (2010). Multi-institutional study of barriers to research utlilisation and evidence-based practice among hosptial nurses. Journal of Clinicical Nursing, 19, 1944-1951. Brown, C. E., Wickline, M. A., Ecoff, L., & Glaser, D. (2008). Nursing practice, knowledge, attitudes and percieved barriers to evidence-based practice at an academic medical center. Journal of Advanced Nursing, 65(2), 371-381. Center for Disease Control and Prevention. (2007). Nursing home care. Retrieved from: http://www.cdc.gov/nchs/fastats/nursingh.htmCenter for Disease Control and Prevention. (2007). The state of aging and health in America. Retrieved from: http://www.cdc.gov/Aging/pdf/saha_2007.pdfChau, J. P.c., Lopez, V., & Thompson, D. R. (2008). A survey of Hong Kong nurses' perceptions of barriers to and facilitators of research utilization. Research in Nursing & Health, 31, 640-649. Flynn, L., Liang, Y., Dickson, G., & Aiken, L. (2010). Effects of Nursing Practice Environments on Quality outcomes in nursing homes. The American geriatric society, 58, 2401-2406. Healthy People (2012). Access to health services. Retrieved from: http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=1Katz, P. R., Karuza, J., Intrator, O., & Mor, V. (2009). Nursing home physician specialist: A response to the workforce crisis in long-term care. Annals of internal medicine, 150(6),411-413.

References

Mathews, J. (2012). Paying for nursing care. Retrieved from:http://www.nolo.com/legal-encyclopedia/choosing-paying-long-term-care-29651-2.htmlMcCloskey, D. J. (2008). Nurses' perceptions of research utilization in a cooperate health care system. Journal of Nursing Scholarship, 40(1), 39-45. Mehrdad, N., Salsali, M., & Kazemnejad, A. (2007). The spectrum of barriers to and facilitators of research utilization in Iranian nursing. Journal of Clinical Nursing, 17, 2194-2202. Murray, C. (2009). Diffusion of innovation theory: A bridge for the research-practice gap in counseling. Journal of Counseling & Developement, 87, 108-116. National Nursing Home Survey. (2004) retrieved from:http://www.cdc.gov/nchs/data/series/sr_13/sr13_167.pdfOfi, B., Sowunmi, L., Edet, D., & Anarado, N. (2008). Professional nurses' opinion on research and research utilization for promoting quality nursing care in selected teaching hospitals in Nigeria. International Journal of Nursing Practice, 14, 243-255. Uysal, A., Temel, A. B., Ardahan, M., & Ozkahraman, S. (2010). Barriers to research utilization among nurses in Turkey. Journal of Clinical Nursing, 19

Questions?