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The care unit in nursing home research: Evidence in support of a definition

BACKGROUND: Defining what constitutes a resident care unit in nursing home research is both a conceptual and practical challenge. The aim of this paper is to provide evidence in support of a definition of care unit in nursing homes by demonstrating: (1) its feasibility for use in data collection, (2...

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Autores principales: Estabrooks, Carole A, Morgan, Debra G, Squires, Janet E, Boström, Anne-Marie, Slaughter, Susan E, Cummings, Greta G, Norton, Peter G
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2011
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3098823/
https://www.ncbi.nlm.nih.gov/pubmed/21492456
http://dx.doi.org/10.1186/1471-2288-11-46
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author Estabrooks, Carole A
Morgan, Debra G
Squires, Janet E
Boström, Anne-Marie
Slaughter, Susan E
Cummings, Greta G
Norton, Peter G
author_facet Estabrooks, Carole A
Morgan, Debra G
Squires, Janet E
Boström, Anne-Marie
Slaughter, Susan E
Cummings, Greta G
Norton, Peter G
author_sort Estabrooks, Carole A
collection PubMed
description BACKGROUND: Defining what constitutes a resident care unit in nursing home research is both a conceptual and practical challenge. The aim of this paper is to provide evidence in support of a definition of care unit in nursing homes by demonstrating: (1) its feasibility for use in data collection, (2) the acceptability of aggregating individual responses to the unit level, and (3) the benefit of including unit level data in explanatory models. METHODS: An observational study design was used. Research (project) managers, healthcare aides, care managers, nursing home administrators and directors of care from thirty-six nursing homes in the Canadian prairie provinces of Alberta, Saskatchewan and Manitoba provided data for the study. A definition of care unit was developed and applied in data collection and analyses. A debriefing session was held with research managers to investigate their experiences with using the care unit definition. In addition, survey responses from 1258 healthcare aides in 25 of the 36 nursing homes in the study, that had more than one care unit, were analyzed using a multi-level modeling approach. Trained field workers administered the Alberta Context Tool (ACT), a 58-item self-report survey reflecting 10 organizational context concepts, to healthcare aides using computer assisted personal interviews. To assess the appropriateness of obtaining unit level scores, we assessed aggregation statistics (ICC(1), ICC(2), η(2), and ω(2)), and to assess the value of using the definition of unit in explanatory models, we performed multi-level modeling. RESULTS: In 10 of the 36 nursing homes, the care unit definition developed was used to align the survey data (for analytic purposes) to specific care units as designated by our definition, from that reported by the facility administrator. The aggregation statistics supported aggregating the healthcare aide responses on the ACT to the realigned unit level. Findings from the multi-level modeling further supported unit level aggregation. A significantly higher percentage of variance was explained in the ACT concepts at the unit level compared to the individual and/or nursing home levels. CONCLUSIONS: The statistical results support the use of our definition of care unit in nursing home research in the Canadian prairie provinces. Beyond research convenience however, the results also support the resident unit as an important Clinical Microsystem to which future interventions designed to improve resident quality of care and staff (healthcare aide) worklife should be targeted.
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spelling pubmed-30988232011-05-21 The care unit in nursing home research: Evidence in support of a definition Estabrooks, Carole A Morgan, Debra G Squires, Janet E Boström, Anne-Marie Slaughter, Susan E Cummings, Greta G Norton, Peter G BMC Med Res Methodol Research Article BACKGROUND: Defining what constitutes a resident care unit in nursing home research is both a conceptual and practical challenge. The aim of this paper is to provide evidence in support of a definition of care unit in nursing homes by demonstrating: (1) its feasibility for use in data collection, (2) the acceptability of aggregating individual responses to the unit level, and (3) the benefit of including unit level data in explanatory models. METHODS: An observational study design was used. Research (project) managers, healthcare aides, care managers, nursing home administrators and directors of care from thirty-six nursing homes in the Canadian prairie provinces of Alberta, Saskatchewan and Manitoba provided data for the study. A definition of care unit was developed and applied in data collection and analyses. A debriefing session was held with research managers to investigate their experiences with using the care unit definition. In addition, survey responses from 1258 healthcare aides in 25 of the 36 nursing homes in the study, that had more than one care unit, were analyzed using a multi-level modeling approach. Trained field workers administered the Alberta Context Tool (ACT), a 58-item self-report survey reflecting 10 organizational context concepts, to healthcare aides using computer assisted personal interviews. To assess the appropriateness of obtaining unit level scores, we assessed aggregation statistics (ICC(1), ICC(2), η(2), and ω(2)), and to assess the value of using the definition of unit in explanatory models, we performed multi-level modeling. RESULTS: In 10 of the 36 nursing homes, the care unit definition developed was used to align the survey data (for analytic purposes) to specific care units as designated by our definition, from that reported by the facility administrator. The aggregation statistics supported aggregating the healthcare aide responses on the ACT to the realigned unit level. Findings from the multi-level modeling further supported unit level aggregation. A significantly higher percentage of variance was explained in the ACT concepts at the unit level compared to the individual and/or nursing home levels. CONCLUSIONS: The statistical results support the use of our definition of care unit in nursing home research in the Canadian prairie provinces. Beyond research convenience however, the results also support the resident unit as an important Clinical Microsystem to which future interventions designed to improve resident quality of care and staff (healthcare aide) worklife should be targeted. BioMed Central 2011-04-14 /pmc/articles/PMC3098823/ /pubmed/21492456 http://dx.doi.org/10.1186/1471-2288-11-46 Text en Copyright ©2011 Estabrooks et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Estabrooks, Carole A
Morgan, Debra G
Squires, Janet E
Boström, Anne-Marie
Slaughter, Susan E
Cummings, Greta G
Norton, Peter G
The care unit in nursing home research: Evidence in support of a definition
title The care unit in nursing home research: Evidence in support of a definition
title_full The care unit in nursing home research: Evidence in support of a definition
title_fullStr The care unit in nursing home research: Evidence in support of a definition
title_full_unstemmed The care unit in nursing home research: Evidence in support of a definition
title_short The care unit in nursing home research: Evidence in support of a definition
title_sort care unit in nursing home research: evidence in support of a definition
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3098823/
https://www.ncbi.nlm.nih.gov/pubmed/21492456
http://dx.doi.org/10.1186/1471-2288-11-46
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