Date Presented 03/28/20
This mixed-methods research project explored knowledge and perceptions of nursing staff about functional maintenance programs in a skilled-nursing facility and evaluated the effects of increased nursing-staff education. The study consisted of pre- and postsurvey and individual interviews. The results showed an increase in scores for both knowledge and perception questions following an in-service training session. Interviews revealed themes related to program benefits and barriers to implementation.
Primary Author and Speaker: Laura Novak
Contributing Authors: Vanessa Jewell
PURPOSE: CMS cites the evaluation for and development of maintenance programs as medically necessary if they require the skills of a practitioner and serve to maintain the current functional level or slow decline (Lanham, 2002). These guidelines have resulted in the development of functional maintenance programs (FMPs), which are often utilized by occupational therapy practitioners upon client discharge from therapy services. With proper and consistent implementation by caregivers, including nursing staff, researchers have demonstrated positive effects of general maintenance programs in nursing facilities. However, Broad (1997) reported that certified nursing assistants (CNAs), transfer into practice only 10-30% of the activities for which they are trained. To facilitate the successful implementation of FMPs, practitioners must first understand the knowledge and perceptions of nursing staff charged with carrying out the FMPs. By understanding these, therapy practitioners may begin to address the barriers and improve the efficacy of these programs, thus improving outcomes for residents in nursing facilities. The purpose of this study was to examine the attitudes and knowledge of nursing staff toward FMPs and to evaluate the effectiveness of education on the attitudes toward these programs.
DESIGN: An explanatory sequential design was utilized, beginning with a pre-/post quasi-experimental design followed by in-depth individual interviews. Participants (n=20) included registered nurses, certified nursing assistants, and licensed vocational nurses from a skilled nursing facility. The researchers developed a 22-question survey with 11 Likert scale questions to assess perceptions and attitudes toward FMPs. Five questions used multiple choice to assess the participants’ knowledge about FMPs.
METHOD: Participants completed a pre-test, attended an in-service session, and completed a post-test addressing knowledge and perceptions about FMPs. Additionally, 5 participants completed individual interviews about their perceptions of FMPs. The pre- and post-test scores were entered into SPSS for data analysis. The Wilcoxon signed-rank test calculated the change in perceptions about FMPs, while the McNemar test calculated the change in knowledge about FMPs.
The researchers used inductive analysis to of describe the participants’ experiences with FMPs. This approach allows perceptions of participants to emerge from the data through thorough comparison of each transcript (Thomas, 2006).
RESULTS: All participants increased test scores from pre-test to post-test. Participants had statistically significant improvement for the question about management support (p<.05), and approached statistical significance for four additional questions (p<.1). Themes from the interviews included: FMPs help residents maintain independence; barriers to implementation include time management, not knowing the programs, and resident refusal; more communication and training are needed; and staff perceive positive collaboration with the therapists.
CONCLUSION: This study supports the growing body of literature which identifies the impact of continued nursing staff education on quality of care. Kim and Tak (2018) indicated that knowledge and attitudes of nursing staff affect care behaviors. However, the education in this study was uni-modal. Further research is necessary to evaluate the effects of multi-modal education. Themes derived from the interviews may be used to develop educational programs which target perceived barriers. Integrated information from this study can be used by practitioners to provide increased education and address perceived barriers to implementation for successful program development.
References
Lanham, S. (2002). Developing post-discharge programs for patients and caregivers. Gerontology: Special Interest Section Quarterly, 25, 3-4.
Broad, M.L. (1997). Overview of transfer training. Performance Improvement Quarterly, 10, 7-21. Doi: https://doi.org/10.1111/j.1937-8327.1997.tb00046.x
Thomas, D. (2006). A general inductive approach for analyzing qualitative evaluation data. American Journal of Evaluation. Retrieved from file:///C:Users/Owner/Downloads/American%20Journal%20of%20Evaluation-2006-Thomas-237-46.pdf
Kim, J., & Tak, S. (2018). Factors influencing care behavior of certified care assistants for older adults with dementia. Journal of Korean Gerontological Nursing, 20, 185-192.
