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Gerontologist. 2018 Mar 19;58(2):e15-e24. doi: 10.1093/geront/gnw255.

Development of a New Tool for Systematic Observation of Nursing Home Resident and Staff Engagement and Relationship.

Author information

Research & Development, Tuscaloosa VA Medical Center, Alabama.
Alabama Research Institute on Aging and Psychology Department, The University of Alabama, Tuscaloosa.
Mental Health Service, VA Boston Healthcare System Brockton Division, Massachusetts.
Center for Healthcare Organization & Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts.
Mental Illness Research, Education & Clinical Center, VA Maryland Health Care System, Baltimore.
Health Law, Policy, & Management, Boston University School of Public Health, Massachusetts.
Alabama Research Institute on Aging and College of Community Health Sciences, The University of Alabama, Tuscaloosa.


Purpose of Study:

To develop a structured observational tool, the Resident-centered Assessment of Interactions with Staff and Engagement tool (RAISE), to measure 2 critical, multi-faceted, organizational-level aspects of person-centered care (PCC) in nursing homes: (a) resident engagement and (b) the quality and frequency of staff-resident interactions.

Design and Methods:

In this multi-method psychometric development study, we conducted (a) 120 hr of ethnographic observations in one nursing home and (b) a targeted literature review to enable construct development. Two constructs for which no current structured observation measures existed emerged from this phase: nursing home resident-staff engagement and interaction. We developed the preliminary RAISE to measure these constructs and used the tool in 8 nursing homes at an average of 16 times. We conducted 8 iterative psychometric testing and refinement cycles with multi-disciplinary research team members. Each cycle consisted of observations using the draft tool, results review, and tool modification.


The final RAISE included a set of coding rules and procedures enabling simultaneously efficient, non-reactive, and representative quantitative measurement of the interaction and engagement components of nursing home life for staff and residents. It comprised 8 observational variables, each represented by extensive numeric codes. Raters achieved adequate to high reliability with all variables. There is preliminary evidence of face and construct validity via expert panel review.


The RAISE represents a valuable step forward in the measurement of PCC, providing objective, reliable data based on systematic observation.

[Indexed for MEDLINE]
Free PMC Article

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