How do we translate evidence-based interventions into practice in nursing homes? For years, researchers have focused on developing standardized, reliable procedures to improve care for nursing home residents. As a result, we now have a myriad of best practices to recommend in a number of areas. However, as we learn what nursing home staff should do, we discover that this often is what they are not doing.
Several reasons account for this chasm between evidence-based practice and usual practice in nursing homes, including staffing problems, rigid regulations, inadequate reimbursement, and poor management. Rarely cited, however, is the role researchers, advocacy groups, policymakers, and other change agents play in their efforts to translate research into practice. To the extent that specific translational efforts have gone unexamined, they represent an area that may significantly advance quality improvement.
That rationale is the basis for this dissertation. The work begins by critically examining the role of nursing home change agents, taking into account evidenced-based principles of innovation dissemination and identifying recommendations to enhance dissemination efforts and speed the translation of research into practice in nursing homes.
These recommendations are then applied to two studies of distance learning courses (one on incontinence management, the other on nutritional care)are promising. In each course, multiple staff members in each participating nursing home were able to attend monthly teleconferences that not only improved their knowledge of the recommended evidence-based intervention but also provided a structure and extended support for implementing that intervention with at least some residents. Most participants reported that they would take a similar course again and would recommend the course to colleagues; 57.1% of all participants (total N=175) said they preferred the distance learning model to a more traditional one- to two-day training program held in a single location. Lessons learned from these evaluations and directions for future translational research are discussed in the concluding chapter.