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Gerontologist. 2018 Jul 13;58(4):e291-e301. doi: 10.1093/geront/gny039.

Impact of Intervention to Improve Nursing Home Resident-Staff Interactions and Engagement.

Author information

Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts.
Department of Health Law, Policy and Management, School of Public Health, Boston University, Massachusetts.
Center for Innovation in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
Department of Medicine - Section of Health Services Research, Baylor College of Medicine, Houston, Texas.
New England Geriatric Research Education and Clinical Center, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts.
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
Institute for Aging Research, Hebrew SeniorLife, Roslindale, Massachusetts.
Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, Alabama.
Alabama Research Institute on Aging and the Department of Psychology, University of Alabama, Tuscaloosa.
Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Massachusetts.
Hospice and Palliative Care, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts.


Background and Objectives:

For nursing home residents, positive interactions with staff and engagement in daily life contribute meaningfully to quality of life. We sought to improve these aspects of person-centered care in an opportunistic snowball sample of six Veterans Health Administration nursing homes (e.g., Community Living Centers-CLCs) using an intervention that targeted staff behavior change, focusing on improving interactions between residents and staff and thereby ultimately aiming to improve resident engagement.

Research Design and Methods:

We grounded this mixed-methods study in the Capability, Opportunity, Motivation, Behavior (COM-B) model of behavior change. We implemented the intervention by (a) using a set of evidence-based practices for implementing quality improvement and (b) combining primarily CLC-based staff facilitation with some researcher-led facilitation. Validated resident and staff surveys and structured observations collected pre and post intervention, as well as semi-structured staff interviews conducted post intervention, helped assess intervention success.


Sixty-two CLC residents and 308 staff members responded to the surveys. Researchers conducted 1,490 discrete observations. Intervention implementation was associated with increased staff communication with residents during the provision of direct care and decreased negative staff interactions with residents. In the 66 interviews, staff consistently credited the intervention with helping them (a) develop awareness of the importance of identifying opportunities for engagement and (b) act to improve the quality of interactions between residents and staff.

Discussion and Implications:

The intervention proved feasible and influenced staff to make simple enhancements to their behaviors that improved resident-staff interactions and staff-assessed resident engagement.

[Indexed for MEDLINE]

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