Implementation leadership of the Resident Assessment Instrument in healthcare services for older people: An interview study of specialists.

AIM: The aim was to explore implementation leadership of the Resident Assessment Instrument in healthcare services for older people from the perspective of specialists. DESIGN: A qualitative descriptive design was used. METHODS: Thematic interviews with 21 specialists were conducted between April 2022 and June 2022 in eight health and social, one educational and one research organization in Finland. The data were analysed with deductive-inductive content analysis using the Resident Assessment Instrument implementation leadership framework developed for this study. RESULTS: In implementation leadership of Resident Assessment Instrument, the need for leaders' support and capabilities to ensure that the conditions and supporting structures for implementation are present was emphasized. Regular and continuous basic and advanced training for professionals and leaders' competencies were identified as crucial factors for a successful implementation process of Resident Assessment Instrument. Leading the active implementation of this instrument requires leaders' strong support and regular communication. The importance of frontline leaders and mentors was also stressed in practical implementation, while the responsibility of upper-level leaders, especially in the use of benchmarking, was underlined for the evaluation and further improvement of organizational operations. In sustaining the implementation, it was emphasized that using the Resident Assessment Instrument is a continuous process that does not end with the implementation itself. CONCLUSION: Implementation leadership of Resident Assessment Instrument has the potential to increase the success of the implementation process. The Resident Assessment Instrument Implementation Leadership Framework can be a useful tool for describing processes, content and leaders' roles in implementation leadership of the instrument in healthcare services for older people. IMPACT: This study provides a comprehensive view of implementation leadership of the Resident Assessment Instrument implementation process in healthcare services for older people. Overall, the results indicate the significance of leadership in successful implementation. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. WHAT DOES THIS ARTICLE CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Successful implementation leadership of Resident Assessment Instrument requires continuous monitoring, supporting and evaluating the implementation process. Organizations that use the Resident Assessment Instrument should strengthen their leaders' knowledge and competencies in implementation leadership to enable the full realization of the instrument's benefits. Leaders and professionals in healthcare services for older people need regular, continuous and correctly targeted basic and advanced training on the Resident Assessment Instrument.

Quality of care plans in long-term care facilities for the older persons-How well is information from RAI assessments utilised in care planning?

BACKGROUND: In Finland, care plans at long-term care facilities (LTCF) for the older persons should be based on information from Resident Assessment Instrument (RAI) assessments and the principles of structured data. Hence, managers are responsible for ensuring that the RAI system is used to a satisfactory extent, the provided information is used in care planning, and that staff members are competent at composing high-quality care plans. AIM: To explore the congruence between first-line managers' assessments of the extent to which care plans include RAI information and separately observed RAI-related contents of care plans. METHODS: The study was based on a descriptive, cross-sectional survey of first-line managers (n = 15) from three LTCF organisations and a randomly selected sample of care plans (n = 45) from two LTCF organisations in Finland. Manager responses and analysis of care plans were reviewed at a general level. The data were gathered in 2019 and analysed using statistical methods and content analysis. RESULTS: First-line managers' assessments of the extent to which their units' care plans included RAI information did not match the observed care plan contents. The care plan analysis revealed that managers significantly overestimated the extent to which care plans included RAI-related content. CONCLUSION: Managers at LTCF organisations need more training to be able to sufficiently support their staff in using RAI information to draft high-quality care plans. IMPLICATION FOR PRACTICE: Care plans must include a higher level of information related to RAI assessments. To develop competencies in drafting high-quality care plans, training related to RAI information utilisation on all aspects of the care plan should be emphasised and training should be provided to first-line managers and more broadly across the nursing staff.

Daily rehabilitation nursing increases the nursing time spent on residents.

Nurses are primary managers of rehabilitation nursing activities. When improving rehabilitation nursing, it is important to understand the content of care provided and time spent on residents. This study discusses the allocation of nursing staff time within a context of rehabilitation nursing. The variables of rehabilitation nursing and residents' characteristics were derived from the Resident Assessment Instrument. The wage-adjusted direct nursing time was obtained from a time measurement study carried out in November 2002 in long-term care facilities in southern Finland. The average direct wage-adjusted nursing time spent on resident was 93.8 min per day. Residents receiving daily rehabilitation nursing were allocated approximately 8 min more wage-adjusted direct nursing time than their peers. More 'hands in care' staff is required for adopting rehabilitation nursing in long-term care units. Maximizing residents' independency should be the goal for rehabilitation care and therefore the focus for allocating both nursing and rehabilitation staff to units and facilities.

Association between rehabilitation care practices and care quality in long-term care facilities.

This article analyzes the association between rehabilitation care practices and quality outcomes in Finland and represents unit-level (n = 256) associations between rehabilitation nursing and quality outcomes. Units classified as units providing a high frequency of rehabilitation care practices had better outcomes in 2 of 5 quality outcomes.

Provision of rehabilitation nursing in long-term care facilities.

AIM: This paper reports an investigation into rehabilitation nursing provided in long-term care settings in Finland, focusing on the amount of time spent with residents, types of rehabilitation nursing provided and resident characteristics associated with rehabilitation nursing. BACKGROUND: In long-term care, nurses have important roles as members of multidisciplinary care teams in the provision of rehabilitation care. Evidence suggests that rehabilitation nursing has a positive impact on maintaining residents' functional performance. However, there is little information on the patterns and scope of rehabilitation nursing in long-term care facilities. METHODS: A quantitative, retrospective and cross-sectional study was designed with the data collected between July and December 2002. Rehabilitation nursing was analysed using the Resident Assessment Instrument used in Finland (n = 5312). The frequency and focus of rehabilitation nursing were presented by mean scores and 95% confidence intervals. Univariate and multivariate logistic regression models were built to describe the factors associated with rehabilitation nursing. Odds ratios and confidence intervals were derived from these models. RESULTS: About 64% of residents received some rehabilitation nursing. Residents assessed as having rehabilitation potential received statistically significantly more rehabilitation nursing than others, such as skills practice in transfer, walking and dressing. Resident factors associated with rehabilitation nursing were cognition, activities of daily living, urinary incontinence, instability of health condition, falls, depression and greater social engagement. CONCLUSION: Specific resident characteristics and nurses' views of rehabilitation potential determine the provision of rehabilitation nursing. This information could be useful in both targeting and planning rehabilitation nursing in long-term care.