Detection of Acute Deterioration in Care Home Residents: A Multicenter Qualitative Exploration of Barriers and Enablers.
Introduction: Delay in detecting acute deterioration in older adults in care homes is associated with avoidable hospitalizations and adverse outcomes, including premature death. Objective: Underpinned by the Knowledge to Action Framework, this study aimed to understand the barriers and enablers to d...
| Published in: | Journal of Nursing Scholarship Vol. 57; no. 4; pp. 576 - 587 |
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| Main Authors: | , , , , , , , , |
| Format: | research tables/charts Journal Article |
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Wiley-Blackwell
Jul2025
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=186526610&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 186526610 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 15276546 6QP jtl: Journal of Nursing Scholarship issn: 15276546 maglogo: Y pubinfo: dt: Jul2025 vid: 57 iid: 4 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 186526610 183674576 186526610 186526610 10.1111/jnu.70005 186526610 ppf: 576 ppct: 11 formats: tig: atl: Detection of Acute Deterioration in Care Home Residents: A Multicenter Qualitative Exploration of Barriers and Enablers. aug: au: MacAndrew, Margaret Sriram, Deepa Chambers, Shirley Spooner, Amy Schnitker, Linda Jack, Leanne Yates, Patsy Beattie, Elizabeth Parker, Christina affil: School of Nursing, Queensland University of Technology, Brisbane Queensland,, Australia sug: subj: Clinical Deterioration Diagnosis Clinical Deterioration Prevention and Control Nursing Home Residents Health Services Accessibility Nursing Home Personnel Psychosocial Factors Nursing Staff, Hospital Psychosocial Factors Nurse Attitudes Human Aged Male Female Funding Source Multicenter Studies Qualitative Studies Exploratory Research Interviews Nursing Staff, Hospital Random Sample Urban Areas Thematic Analysis Descriptive Statistics Decision Making Scope of Nursing Practice Communication Teamwork Experiential Learning Health Resource Utilization Support, Social Workforce Work Capacity Evaluation Aged: 65+ years Male Female ab: Introduction: Delay in detecting acute deterioration in older adults in care homes is associated with avoidable hospitalizations and adverse outcomes, including premature death. Objective: Underpinned by the Knowledge to Action Framework, this study aimed to understand the barriers and enablers to direct care staff detecting and responding to the early signs of acute deterioration in care home residents. Study Design: Online focus groups or interviews with regulated (registered and enrolled nurses) and unregulated (assistants in nursing and personal care workers) direct care staff from participating care homes were conducted. Homes were recruited using disproportionate stratified random sampling to include metropolitan, inner regional, and outer regional care homes. Interview and focus group recordings were transcribed verbatim and analyzed using inductive thematic analysis. Results: Eighty direct care staff (n = 48 regulated; n = 32 unregulated) from eight care homes participated. Fifteen focus groups (n = 7 unregulated staff, n = 8 regulated staff) and two interviews (n = 1 regulated staff, n = 1 unregulated staff) were conducted between July 2021 and October 2022. Four themes related to the barriers and enablers of detecting and responding to acute deterioration were generated: decision‐making within the scope of practice; resource availability; streamlined communication; and teamwork. Conclusion: Findings highlight the challenges direct care staff encounter in being able to detect early signs of acute deterioration and implement appropriate care pathways. Perceived barriers and enablers highlighted in this study need to be considered when developing and implementing programs to optimize the timely detection of, and response to, acute deterioration in care homes. Clinical Relevance: Workforce knowledge, experience, and confidence deficits are significant barriers to detecting acute deterioration, while the unique workforce mix in care homes poses additional challenges for the accurate detection of early signs of acute deterioration. Knowing the resident, working as a team, and valuing the contribution of aged care staff and families in managing acute deterioration are enablers to achieving better outcomes for residents experiencing acute deterioration. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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