Improving Outcomes for Frail Seniors: Impact of ASILA Program for Long-Term Staff
The Applied Simulated and Integrated Learning Approach (ASILA) program was designed with input from seniors and other knowledge users (e.g. families, patient advocates, resident councils, educators) and then pilot tested for effectiveness with a convenience sample. Necessary refinements were made and the program was then delivered over the course of three days in two nursing homes.
About the Project
The ASILA program includes three evidence-informed simulated case scenarios addressing current deficits in care for frail seniors; each module including a Comprehensive Geriatric Assessment (CGA) and the use of appropriate assessment tools and documentation, care planning and reporting systems.
Initial knowledge scores were measured by means of a questionnaire, then re-assessed immediately after the ASILA program. Focus group interviews were also conducted with staff upon completion of the intervention. Three months after the program was delivered, staff was asked to complete the questionnaires again to assess knowledge retention and practice. Additionally, clinical data was obtained from residents in the care of the participating staff to assess pre- and post-program differences.
These pilot findings indicate that the ASILA program could be a successful approach to support nursing home staff to improve resident assessment, care and documentation.
Project Team
Principal Investigator:
Veronique Boscart, PhD, MEd, MScN, RN– Conestoga College Institute of Technology and Advanced Learning
Co-Investigators:
George Heckman, MD, MSc, FRCP(C) — University of Waterloo
John Hirdes, PhD — University of Waterloo
Knowledge Users and Partners:
Josie d’Avernas, MSc — Research Institute for Aging
Marlene Raasok, BScPharm, MHSA — Conestoga College
David Sawatzky
James Schlegel
Project Contact: Veronique Boscart — vboscart@conestogac.on.ca
CAT 2013-47
Key words: training; frailty; minimum data set; long-term care; residents
Presentations
Boscart, V., Heckman, G., Eckel, L., Heyer, M., Hirdes, J. Developing the Applied Simulated and Integrated Learning Approach (ASILA) Program. 2nd Annual TVN Conference on Improving Care for the Frail Elderly. Toronto, ON. September 23, 2014.
Boscart, V., Heckman, G., Eckel, L., Heyer, M., Hirdes, J. The Applied Simulated and Integrated Learning Approach (ASILA) program for LTC. Conestoga College and Schlegel – University of Waterloo Research Institute for Aging Steering Committee meeting. October 3, 2014.
Boscart, V., Heckman, G., Hirdes, J. The Applied Simulated and Integrated Learning Approach (ASILA) program for LTC. It takes a Village. Presented at the Schlegel Villages and Research Institute for Aging Innovation Summit. June 24, 2015.
Boscart, V., Heckman, G., Heyer, M., Hirdes, J. Enhancing care for frail seniors through the ASILA program. 3rd Annual TVN Conference on Improving Care for the Frail Elderly. Toronto, ON. September 27, 2015.
Boscart, V., Heckman, G., Hirdes, J., Heyer, M. Eckel, L., Zehr, M. Improving outcomes for frail seniors: Impact of the ASILA program for long-term care staff. Accepted for presentation at the 2015 Canadian Association on Gerontology Annual Meeting. Calgary, AB. October 2015.
Boscart, V., Heckman, G., Eckel, L., Heyer, M., Hirdes, J. Applied learning in nursing homes: Applied simulated and integrated learning approach program. Accepted for presentation at the 2015 Gerontological Society of America Annual Meeting. November 2015.
Boscart, V., Heckman, G. Improving outcomes for frail seniors: Impact of the ASILA program for long-term care staff. Accepted for presentation at the 2015 Nursing Home Research International Working Group. Toulouse, France. December 2015.
Lay Title: Improving care of seniors living with frailty in nursing homes
Key Findings:
- Personal support workers (PSWs) said that they learned more about using a tool called the “Minimum Data Set” (MDS 2.0) for people who live in nursing homes.
- PSWs felt that using the MDS findings improved their confidence while caring for people living in nursing homes. The PSWs felt that the care they gave was what the people living in nursing homes needed.
- Even though PSWs felt that they were aware of the needs of people who live in nursing homes, there were some care challenges that were difficult to improve
Why was this study was needed?
There are more older people who live in nursing homes who need complex care. The types of needs these people have can be shown using an assessment tool called the “Minimum Data Set” (MDS 2.0). Personal support workers (PSWs) who work in nursing homes are the ones who spend the most time with the people who live there; however, PSWs are not trained to use the tool that can help show what the needs of these people are. PSWs should understand how to use the findings of this assessment in their care.
Suggestions on how these findings could impact frail older adults and/or their family caregivers and how this might be measured:
- Training PSWs to look at the MDS tool can help determine important changes in care for people who live in nursing homes. PSWs will then be able to communicate these changes to the rest of the care team to give the best possible care.
- Including PSWs in the MDS assessment can improve the care of people who live in nursing homes.
Brief comment on type of study in lay terms:
- The purpose of this study was to improve PSWs knowledge on an assessment tool called the MDS used in nursing homes.
- We conducted a research study that used surveys and observations.
- The study involved 23 PSWs in two Canadian provinces.
- We wanted to increase PSW knowledge about complex care by training them to use the MDS tool. We also hoped to show that PSW training with the MDS tool led to improved health for people who live in nursing homes.
Lay Title: Improving care of seniors living with frailty in nursing homes
Key Findings:
- After being trained to use the Minimum Data Set (MDS 2.0) assessment tool, personal support workers (PSWs) in nursing homes felt more knowledgeable and confident using the tool for resident assessment.
- PSWs were more confident in using results of the MDS assessment in their care for residents and felt that the care they provided was more tailored to the residents’ needs.
- Although PSWs felt that they were more aware of residents’ complex needs, MDS training did not improve clinical outcomes (e.g., falls, pressure ulcers).
Why was this study was needed?
There is a growing proportion of seniors in nursing homes with complex care needs. The MDS 2.0 tool is commonly used to assess these care needs. Although PSWs spend more time with residents than other members of the care team, they are not trained to use assessment tools. As a result, PSWs may miss opportunities to communicate important changes in resident care to other members of the care team.
Suggestions on how administrators or policy maker could use the findings:
- Healthcare students are rarely taught to use MDS 2.0 assessment tools which may lead to missed care opportunities. Including specific geriatric topics (e.g., falls, delirium) as part of continued education courses can help staff to recognize important changes in residents’ care needs.
- Incorporating an educational program such as the Applied Simulated and Integrated Learning Approach (ASILA), which includes a detailed training guide, can help ensure that important course concepts are translated into healthcare practice.
Brief comment on type of study in lay terms:
- We aimed to improve personal support workers’ familiarity with MDS assessment tools.
- The study included quantitative and qualitative outcomes using a repeated measures design.
- Participants were 23 PSWs in two Canadian provinces.
- Our primary outcome was PSW knowledge about MDS assessment and its application, as measured by questionnaire scores up to three months after the educational training.
- Our secondary outcomes were clinical outcomes of nursing home residents, gathered up to three months after PSW training.
Lay Title: Improving care of seniors living with frailty in nursing homes
Key Findings:
- After the ASILA Program, personal support workers (PSWs) in the nursing home felt more knowledgeable and confident using the Minimum Data Set (MDS 2.0) resident assessment and care screening tool.
- PSWs were more confident in caring for residents and felt that the care they provided was more tailored to the residents’ complex needs.
- Although PSWs felt more aware of residents’ needs and confident in their care delivery, there was no improvement in resident clinical outcomes (e.g., falls, pressure ulcers).
Why was this study needed?
There is a growing proportion of seniors in nursing homes with complex care needs. The MDS 2.0 tool is commonly used to assess these care needs. Although PSWs spend more time with residents than other members of the care team, they are not trained to use assessment tools. As a result, PSWs may miss opportunities to communicate important changes in resident care to other members of the care team.
Brief overview of the methodology:
- We aimed to improve personal support workers’ familiarity with MDS assessment tools.
- The study included quantitative and qualitative outcomes using a repeated measures design.
- Participants were 23 PSWs in two Canadian provinces.
- Our primary outcome was PSW knowledge about MDS assessment and its application, as measured by questionnaire scores up to three months after the educational training.
- Our secondary outcomes were clinical outcomes of nursing home residents, gathered up to three months after PSW training.
Potential impact of findings on clinical practice/patient care and how this impact might be measured:
- Increased knowledge and use of MDS 2.0 assessment tools among PSWs can help identify important changes in residents that should be communicated to the rest of the care team in order to optimize care for older residents living with frailty.
- Care teams in nursing homes should facilitate open communication between PSWs and nursing staff. The communication may be formal or informal and can be documented to determine frequency and efficacy.
Remaining knowledge/research gaps:
- Because this was a pilot study, the study duration and number of participants were limited. It is possible that increasing the number of PSWs and increasing the duration of follow-up could improve resident clinical outcomes following MDS 2.0 assessment training.
- It was unclear how the MDS 2.0 assessment training affected communication patterns among care teams. Future research should investigate how communication can be improved to help ensure care opportunities are not missed.
CFN Webinar (March 23, 2016): ASILA case-simulation prototype on cognitive and physical outcomes of frail seniors in nursing homes