Connection, regulation, and care plan innovation: a case study of four nursing homes.

Published

Journal Article

We describe how connections among nursing home staff impact the care planning process using a complexity science framework. We completed six-month case studies of four nursing homes. Field observations (n = 274), shadowing encounters (n = 69), and in-depth interviews (n = 122) of 390 staff at all levels were conducted. Qualitative analysis produced a conceptual/thematic description and complexity science concepts were used to produce conceptual insights. We observed that greater levels of staff connection were associated with higher care plan specificity and innovation. Connection of the frontline nursing staff was crucial for (1) implementation of the formal care plan and (2) spontaneous informal care planning responsive to changing resident needs. Although regulations could theoretically improve cognitive diversity and information flow in care planning, we observed instances of regulatory oversight resulting in less specific care plans and abandonment of an effective care planning process. Interventions which improve staff connectedness may improve resident outcomes.

Full Text

Duke Authors

Cited Authors

  • Colón-Emeric, CS; Lekan-Rutledge, D; Utley-Smith, Q; Ammarell, N; Bailey, D; Piven, ML; Corazzini, K; Anderson, RA

Published Date

  • October 2006

Published In

Volume / Issue

  • 31 / 4

Start / End Page

  • 337 - 346

PubMed ID

  • 17077708

Pubmed Central ID

  • 17077708

Electronic International Standard Serial Number (EISSN)

  • 1550-5030

International Standard Serial Number (ISSN)

  • 0361-6274

Digital Object Identifier (DOI)

  • 10.1097/00004010-200610000-00009

Language

  • eng