Journal of Gerontological Nursing

Feature Article Supplemental Data

A Client-Centered Community Engagement Project: Improving the Health and Wellness of Older Adults in an Assisted Living Facility

Madeleine Ballantyne-Rice, BSC; Kayla Chopp, BSC; Lisa Evans, BSC; Vanessa Ho, BSC; Wan Ping Hsiung, BSC; Marian Alexandra Simon, BSC; Kaiyu Wu, BSC; Tam Truong Donnelly, PhD

Abstract

Central to nursing practice is the promotion of health and wellness practices. Drawing on the Community as Partner Model, nursing process, Nursing Interventions Classification, and Logic Model, second-year nursing students collaborated with staff and residents of an assisted living facility to promote health and wellness in the older adult population. Windshield surveys, resident surveys, key informant interviews, and focus group interviews were conducted to gain insight into the perceptions and experiences of staff and residents. The majority of residents indicated they were satisfied with life at the facility and their needs have been adequately met. Strengths and areas for improvement were identified in several aspects, including the facility atmosphere and location, quality of staff and health care services, recreational and dietary services, and social support networks. By partnering with community key stakeholders, valuing all different perspectives, and connecting theory to practice, a successful client-centered community clinical project was demonstrated. [Journal of Gerontological Nursing, 42(8), 44–51.]

Abstract

Central to nursing practice is the promotion of health and wellness practices. Drawing on the Community as Partner Model, nursing process, Nursing Interventions Classification, and Logic Model, second-year nursing students collaborated with staff and residents of an assisted living facility to promote health and wellness in the older adult population. Windshield surveys, resident surveys, key informant interviews, and focus group interviews were conducted to gain insight into the perceptions and experiences of staff and residents. The majority of residents indicated they were satisfied with life at the facility and their needs have been adequately met. Strengths and areas for improvement were identified in several aspects, including the facility atmosphere and location, quality of staff and health care services, recreational and dietary services, and social support networks. By partnering with community key stakeholders, valuing all different perspectives, and connecting theory to practice, a successful client-centered community clinical project was demonstrated. [Journal of Gerontological Nursing, 42(8), 44–51.]

Fundamental to nursing practice across the age continuum is the promotion of health and wellness. Engaging community members as active participants in health requires nursing competency and skills in different levels (i.e., novice to expert level of practice) and paradigms, including science, art, ethics, and personal knowledge (Carper, 1978). Promoting the health and well-being of community members requires a partnership approach and collaboration with community members, organizational representatives, and health care professionals in all aspects of the community development process. Second-year nursing students completing clinical requirements for a Bachelor Degree of Science in Nursing (BSN) elected to develop a community health wellness promotion project in an assisted living facility (i.e., The Lodge) for older adults. The facility, located in the northwest quadrant of Calgary for approximately 2 decades, is a retirement community with an average residents' age of approximately 85. As a private and non-governmental subsidized institution, this independent assisted living facility provides accommodation, dining services, housekeeping services, social and recreational activities, and supportive care services to 135 older adult residents.

Drawing on the Community as Partner Model (Vollman, Anderson, & McFarlane, 2012), nursing process (Kozier et al., 2014), and Nursing Interventions Classification (NIC; Bulechek, Butcher, Dochterman, & Wagner, 2013), in collaboration with the staff and residents of The Lodge, the current authors sought to promote health and wellness in the older adult population. The current article (a) reports findings of community health assessment; and (b) presents community health diagnosis, potential community interventions (including the logic model), and recommendations regarding implementation and evaluation for effectiveness and sustainability of promoting older adults' health and well-being. An example of effective community collaboration and partnership is also presented. The authors hope to inspire educators, nursing students, and students of other health care disciplines to actively engage in the promotion of health and well-being of older adults. It is important to consider that this project was a community development project and not a research study. Therefore, institutional research ethics board approval was not sought. However, ethics principles were strictly applied. Information regarding the community project, participants' rights, and steps taken to ensure privacy, confidentiality, and anonymity were clearly explained to participants prior to obtaining their voluntary participation.

Community Health Assessment

A community assessment explores the lived experiences and perceptions among staff and residents revealing factors affecting health (Vollman et al., 2012). In addition, a community assessment study seeks to gain a comprehensive perspective of the needs, strengths, and social and cultural dynamics of the respective community. The current assessment contributed to the development of appropriate and effective health promotion intervention strategies for residents of The Lodge. Furthermore, central to community development is enhancing existing strengths and resources and support, and expanding/enriching social structures, enabling community members to improve health (Canadian Community Health Nursing, 2011; Israel, Schulz, Parker, & Becker, 1998; Stamler & Yiu, 2012; Vollman et al., 2012). Thus, identifying the strengths and areas for improvement was another objective for the current team community assessment.

Data Collection Methods

Multiple data collection methods were used to safeguard reliability and credibility and ensure individual and collective voices were incorporated into the findings (Vollman et al., 2012). Data collection methods include focus groups, windshield and resident surveys, and key staff and resident informant interviews.

Windshield Surveys

A windshield survey was used to examine the nature and essence of The Lodge community and surrounding area through detailed observation. Teams of nursing students gathered information in the assigned locations on foot or by car. To understand the social setting and lives of the residents, team members took note of the observable characteristics of The Lodge, the community in which The Lodge is situated, and the surrounding suburban communities in close proximity to the facility. Observations and associated raw data related to the community core (i.e., the population's social demographics, such as age, sex, ethnic distribution, cultural, and socioeconomic status), subsystems (i.e., physical environment, safety and transportation, health and social services, communication, education, politics and government, economy, and recreation) (Vollman et al., 2012), and perceptions were recorded for future analysis.

General Resident Survey

A quantitative survey approach with a structured questionnaire was used to gather information from the resident population. The structured questionnaire items were developed specifically for the current project using an approach similar to Survey-Monkey® (i.e., an online survey tool; access https://www.surveymonkey.com). A series of close-ended questions were used to obtain the demographic data of each participant. Age, gender, length of stay, and use of home-care services were gathered and incorporated into the data set. Questions with Likert scale measurement of responses were used to gather information on satisfaction of services at The Lodge, frequency of social interaction, likelihood of accessing home-care services, likelihood of suggesting The Lodge to a friend, and respondents' perceived level of independence. Open-ended questions were also asked to provide residents an opportunity to explain their responses and provide suggestions on ways to improve the health and well-being for residents at the facility. A total of 135 questionnaires were distributed to residents. A total of 69 (51% response rate) were returned for review and tabulation.

Key Informant Interviews

The purpose of the key informant interview was to gain insight into the perceptions and lived experiences of both staff and residents (DiCicco-Bloom & Crabtree, 2006). Individual in-depth interviews using a semistructured questionnaire comprising open-ended questions were conducted with staff and residents. For staff, all managers; key members of the health care team, including RNs, licensed practical nurses (LPNs), and health care aides (HCAs); and staff from housekeeping services were interviewed. Data were gathered on the role of the employee, strengths and areas for improvement for The Lodge, and staff perceptions regarding residents' needs.

Resident informants were selected from a compiled resident list provided by the Resident Manager and based on availability and willingness to participate in the interview process. Resident informants were asked a series of open-ended questions to gather information on length of stay, strengths and areas for improvement for The Lodge, perceived needs, and how to foster their health and wellness. The key informant interviews process took place over a period of 3 weeks until data saturation was reached. In total, key informant interviews were completed with 18 staff and managers and 30 residents.

Focus Group Interviews

Clark et al. (2003) recommend focus groups, or community-based inquiry, as one method of identifying community health needs and evaluation of delivery of health care services. Likewise, Vollman et al. (2012) describe the focus group method as a group of individuals with shared interest and perception in a topic convened to discuss their perspectives. Focus groups are beneficial to data collection as emerging themes from other relevant sources and surveyors attempt to define or enrich the scope of the theme (Vollman et al., 2012).

Two discrete focus groups with 16 residents were conducted to substantiate outcomes culled from key informant interviews and resident surveys. A PowerPoint® presentation was crafted identifying strengths of The Lodge and recommendations for potential change. Residents were encouraged to confirm the credibility/accuracy of the findings as well as offer any additional thoughts or reactions to the presentation. The conversations generated from the focus group discussions were recorded to note any new findings and themes consistent or different with the overall findings.

Data Analysis

Representative resident demographic data obtained from general resident surveys were statistically analyzed to generate categorical graphs. Windshield surveys were conducted at different levels (i.e., within The Lodge, the community in which the facility is located, and the surrounding communities in the northwest quadrant of the city) to familiarize the authors with The Lodge and obtain descriptive data. Data were consolidated and evaluated for pertinent information relevant to the current project. Areas considered were community history, demographics, ethnicity, values and beliefs, physical environment, health and social services, economy, transportation and safety, politics and government, communication, education, and recreation. In addition, relevant secondary data about the community were obtained by online search and access to public government statistics.

A general survey was conducted to secure quantitative residents' satisfaction data relevant to life at The Lodge. The survey explored reactions to daily social interaction opportunities, food services, security, transportation, recreation and entertainment, and leadership. Descriptive statistics were used to analyze data obtained from the survey to produce interpretable information on resident satisfaction with regard to the aforementioned factors. Responses to the open-ended questions from the survey were analyzed and triangulated with data obtained from key informant interviews and focus groups.

Key informant narratives were compiled and analyzed for themes. Focus group transcripts were also analyzed to validate previous findings. Themes were subsequently organized into strengths and areas for improvement.

Results

Demographics and Windshield and General Survey Responses

According to a 2014 civic census, 12% (652) of the 5,518 inhabitants of the local community in which the facility is located were 65 or older, as compared to 10% of the 1,195,194 inhabitants of the City of Calgary (2014). Of the 652 older adult residents of the local community in which the facility is located, 135 reside in The Lodge with a mean age of 85. Approximately 68% of The Lodge's residents are female, and currently, 99% are Caucasian. Key informant interviews and the survey show that residents' length of stay varied from less than 1 year to more than 10 years, with approximately 42% of residents staying 2 to 5 years.

Staff comprised eight managers, 32 health care staff (10 LPNs and 22 HCAs), as well as 58 housekeeping, reception, and dining services staff. The ethnicity of the staff is more diverse than the resident population.

The interior features of The Lodge serve to underscore or reduce safety hazards while enhancing quality of life. Safety measures include a call bell system and latch system alerting staff to resident departure from their room, hallway support or stabilization bars, fire extinguishers, and accessible automated external defibrillators (AEDs). The Lodge living designs are dedicated to optimizing socialization, recreation, fitness, nutritional requirements, and reading. Additional building design features, such as large windows, enhanced illumination, comfortable furniture and carpeting, fireplaces, and other decors, serve to create a homey and welcome experience for residents.

Exterior features of The Lodge include spacious sidewalks, generous landscaping, and groomed lawns. However, visible signage to residents and guests is inadequate. Spiritual needs of The Lodge residents are supported through weekly facility nondenominational services. Access to traditional and nontraditional faith denominations can be found within the proximal community.

Other services available to residents include a library, kitchen and laundry services, salon, health center, activity room, and receptionist desk. Lodge-provided transportation assists residents to medical clinics, banks, restaurants, dental offices, and pharmacies. Residents are free to operate vehicles, use public transit, or arrange transport through family or friends. Residents may also qualify for Senior City Program transportation services.

Communication within The Lodge is facilitated through information boards, the library, mailboxes, radio, WiFi access, and a monthly newsletter. Management and resident communication exchanges occur via resident council meeting, open door policy, and opportunity to opine through the resident suggestion box. The Resident Council, a small group representing residents, conveys ideas and concerns to the management team. Data collected from the principle observation methods were reviewed, presented, and endorsed by the key informants at a Lodge town hall meeting. Overall, residents expressed satisfaction with quality of life afforded at The Lodge. Data analysis identified shared areas of interest (Figure).


General survey responses showing residents' satisfaction with (A) daily social interaction, (B) health care services, (C) food services, and (D) leadership.

Figure.

General survey responses showing residents' satisfaction with (A) daily social interaction, (B) health care services, (C) food services, and (D) leadership.

Data collected from windshield surveys, general resident surveys, and staff and resident key informant interviews were analyzed, presented, and confirmed for comprehensiveness and accuracy with the residents in two focus group interviews and a presentation where all staff and residents were invited to attend. Data analysis highlighted common areas of staff and residents' interest. These areas, identified both in terms of strengths and areas for improvement, include the facility's atmosphere, geographical location, quality of staff, quality of recreational activities, dietary services, quality of health care services and other general services, and social support networks.

Strengths

Noted strengths were the high quality of health care services provided at The Lodge and prompt health care staff response. A unique relationship with the province's publicly funded health care system includes home-care services and underscores accountability and quality of care. In addition, access to health care contributes and sustains the overarching goal of assisted living facilities: independent living for residents.

The quality of staff was perceived to be high. Staff were generally perceived to be attentive, accommodating, friendly, and easily accessible. Their hard work is recognized and appreciated by the majority of residents.

Per survey responses, dietary services was shown to accommodate residents in regard to menu planning, attention to nutritional content, dietary restrictions, and personal preferences.

Another strength was the reciprocal nature of staff-to-resident exchange, which not only engenders genuine care and regard, but is likewise inherent in the social support practices.

The diversity and accessibility of recreational activities were highlighted as strengths. Adequate budget and services allowed for proper maintenance of The Lodge, as well as enhanced the quality of life of residents by providing access to a library, salon, lounge, and housekeeping services.

Areas for Improvement

Despite the positive comments regarding access to health care services, residents and staff alike expressed concern about the number of available health care and weekend coverage. Staff and residents acknowledged the compromised quality of care due to staffing constraints and high staff turnover rates. Increased staffing during weekend and overnight shifts was perceived to be a need that is hard to address by management. Staff training could also be improved with respect to health education and knowledge.

The route and schedule of Lodge-provided transportation need to be expanded to better meet the needs of residents. Residents also suggested that they would benefit from a greater variety of recreational activities that are active, educational, ability-appropriate, and sustainable. Some residents identified that dietary services could better address the dietary needs of residents related to specific health conditions, such as cardiovascular disease, weight management, and diabetes management.

It was also found that many residents lack sufficient knowledge of all the available health care services The Lodge and province health care system can provide; therefore, they may have difficulties finding resources and assistance.

Suggestions were made to improve the social support network to promote social inclusion and socialization. Effective and timely communication between hospital and The Lodge health care staff was also a noted area that needs improvement, as well as effective and timely communication among residents, their families and managers, and health care and housekeeping staff.

Another suggestion was to enhance the education of staff and residents regarding cognitive decline and memory loss as well as minimizing stigma surrounding accessing home-care services and Alzheimer's disease. There is a misconception that accessing home-care services is indicative of frailty, creating a barrier among residents who require support. In addition, those not receiving the appropriate level of care from the health care staff are at risk for injuries from falls and improper self-administration of medication. Community environmental management and risk protection were also areas needing improvement.

As suggested by Vollman et al. (2012) in the Community as Partner Model, the authors developed several community diagnoses (Table). The NIC by Bulechek et al. (2013) was used to develop community intervention and implementation (Table A, available in the online version of this article) and suggest ways to evaluate intervention strategies for effectiveness and sustainability (Table B, available in the online version of this article). The Logic Model (Table C, available in the online version of this article) was developed as a guide to assist future groups of nursing students who will continue working with the community to improve health and well-being of older adults living in assisted care facilities (Dwyer & Makin, 1997; Taylor-Powell & Henert, 2008).


Community Diagnosis of The Lodge
Community Diagnosis of The Lodge

Table:

Community Diagnosis of The Lodge


Community Intervention and Implementation
Community Intervention and Implementation
Community Intervention and Implementation
Community Intervention and Implementation

Table A:

Community Intervention and Implementation


Program Evaluation
Program Evaluation
Program Evaluation

Table B:

Program Evaluation


Logic Model - Improving the Health and Wellness for Seniors Living in Assisted Care Facility

Table C:

Logic Model - Improving the Health and Wellness for Seniors Living in Assisted Care Facility

Discussion

As part of the Community Health practicum project, the current group of 2nd-year BSN students began to perform the role of RNs in practice with individuals and their communities. Recognizing the role of community health nurses is to partner with individuals where they live, work, learn, worship, and play to promote, protect, and preserve the health of individuals, families, groups, communities, and populations (Canadian Community Health Nursing, 2011). Thus, the current authors collaborated with the staff and older adult residents at an assisted living facility in a large city in one of the Canadian western provinces. Partnering with community members by engaging in a community project, nursing students gain a deeper understanding of the impact of social/ecological determinants of health and the practical application of community health principles with individuals and groups across the lifespan, in a variety of community settings.

RNs working in the community health arena focus on meeting clients' health needs and use a variety of strategies to promote the health of community and individuals. Because the health of individuals and communities is a complex interrelationship influenced by broad determinants of health and multiple environmental factors (Richard, Gauvin, & Raine, 2011), prior to developing an intervention program aimed at improving the health and well-being of residents, a comprehensive assessment process was implemented. The multiple assessment methods used included a series of windshield surveys, a general resident survey, key informant interviews with staff and residents, and focus groups to gain insight into the perceptions and experiences of the staff and residents, as well as identify the strengths and areas of improvement for health and wellness. The data gathered indicated high satisfaction in regard to The Lodge, staff, and services provided. The current comprehensive assessment highlights many strengths and identifies some areas for improvement regarding residents' health and wellness. At the end of the authors' practicum, they presented The Lodge with a final report containing all findings and recommendations that arose from the project. A PowerPoint presentation was also shown to residents, support staff, health care workers, and managers at The Lodge. This opportunity was used to recommend potential interventions that could significantly improve residents' health and wellness, as well as express appreciation for the support, enthusiasm, and collaboration that they provided in regard to completion of the project.

Because the current practicum nursing group was the first group of students partnering with residents and staff at The Lodge, a thorough assessment was conducted and comprehensive intervention strategies for future practicum groups were suggested. The authors' hope is to engender/encourage future clinical groups to continue this formative work. It is also suggested that future student groups working with researchers and community members conduct evaluations to ensure that any interventions implemented are appropriate, relevant, effective, and sustainable. To make significant contributions to the promotion of health for older adults, it is imperative for researchers and students to engage community members as partners to capture more comprehensive client-centered worldviews, lived experiences, and contexts of their health care practice.

Conclusion

In working with community to promote health and wellness, valuable experience and skills in collaborating and developing effective professional working relationships can be gained. The opportunity to integrate and apply theoretical knowledge of client-centered care and community health nursing learned in theory courses to practice, and to develop the skills and competencies required to effectively care for individuals, groups, communities, and populations is valuable. By partnering with all levels of community members, valuing different perspectives, and connecting theory and practice, the current client-centered community engagement project was successful.

References

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  • City of Calgary. (2014). 2014 civic census results. Retrieved from http://www.calgary.ca/CA/city-clerks/Pages/Election-and-information-services/Civic-Census/2014-Results.aspx
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Community Diagnosis of The Lodge

DescriptionFocusEtiologyManifestations
Positive attributes conducive to the promotion and support of health and wellnessResidents and staffRelated to (a) staff dedication, (b) high quality of health care services, and (c) pleasant atmosphere and beautiful environment

Staff and residents' complimentary statements

Student observations via windshield surveys

Risk of lack of informationResidents and staffRelated to (a) lack of awareness, continuing education, and specific training for support related to recognition and care for dementia and Alzheimer's disease (AD); (b) lack of information about other prevalent health conditions in the relevant population; and (c) misinformation or inadequate information about available home-care services

Home-care nurse's view of the prevalence of dementia within the residents of The Lodge and inadequate detection of it

Staff statements of need for better education regarding the detection of early AD

Staff statements of need for specific programming related to dementia and AD

Reported sense of social stigma related to dementia and AD by staff and some residents

The stated confusion of some residents about how to access home-care services and what other services are available to them

Risk of injuryResidentsRelated to (a) issues of pedestrian safety, such as inadequate visibility of pedestrian crossing signs; and (b) limited health care staff at certain times of the day (e.g., overnight, weekends)

Observations of unsafe pedestrian conditions by residents and students

Resident concerns about the nursing staff-to-resident ratio at night and on weekends

Risk of declining health statusResidentsRelated to (a) the aging process; (b) reluctance of some residents to ask for assistance and access Homecare Services; (c) stigma related to a decline in health status and loss of cognitive and daily functional ability; (d) residents' negative connotations of transitions to higher level of care; and (e) a lack of social support networks for individuals with dementia and their family caregivers

Stated confusion of some residents about how to access home-care services and what services are available

Uncertainty that residents will be forced to move to a different care facility if they experience a change/decline in health status

Limited instances of self-referral to home-care services

Reported feelings of social isolation by residents with dementia and their family caregivers

Risk of inadequate health care servicesResidentsRelated to (a) unclear communication or underdeveloped procedures surrounding post-hospitalization care; (b) lack of adequate health education about certain health conditions; (c) staffing constraints; and (d) inaccessibility of preferred health care services

Residents' perceptions of variance in knowledge and skill level of health care staff, particularly in relation to certain health conditions

Limited staff at certain times of day and days of the week

Statements by staff of inadequate communication between health care staff related to changes in residents' health care statuses

Difficulty accessing health care services outside of the area due to limited transportation

Risk of social isolationLess sociable residentsRelated to (a) lack of volunteer companion program; (b) limited interaction with friends and family outside of The Lodge; (c) limited interaction with other residents within The Lodge; and (d) stigma related to lower functional ability, poor health, and mental health issues

Limited attendance by some residents of social activities organized by The Lodge

Staff observations of the existence of mental health issues, such as depression and anxiety, in the resident population

Staff and resident observations of some residents' reluctance to socialize/associate with residents who have lower health statuses than themselves

Community Intervention and Implementation

InterventionExplanationAction StrategiesLevel of ActionLevel of PreventionImplementation/Recommendation
Health education for staff and residentsProvide staff and residents the health knowledge and learning experience regarding a variety of chronic diseases, such as memory loss, Alzheimer's disease, diabetes, and cardiovascular diseases

Health educator provided information to all interested individuals via workshops, seminar presentations, etc.

Assist individuals, families, and communities in clarifying health beliefs and values

Identify resources that are available for staff, residents, and their caregivers

Provide a supportive environment in which individuals and groups feel safe expressing their views

Individual CommunityPrimary Secondary

Contact Alzheimer's Society to see if it is possible for an information session.

Conduct a “train the trainer” session so that management can provide information sessions to the residents.

Have a dietician come in to assist residents with snack management (i.e., when shopping, what they should buy to stock in their kitchenette that is healthy and appropriate if they have health issues).

Provide ongoing education for staff and residents for relevant health issues by inviting speakers and having information sessions.

Create an FAQ sheet for residents regarding dietary services for when they return from the hospital or fall ill and cannot make it to the dining room for meals. Residents may not be aware of the complementary meal services in these situations.

Caregiver Support (NIC)Support caregivers by providing them with the necessary information to take care of their families or friends who have chronic illnesses. Moreover, monitor caregivers for indicators of stress and support their coping strategies.

Determine caregivers' level of knowledge

Acknowledge difficulties of caregiving role

Explore with caregiver how they cope

Explore ways to support caregivers

Record all assessment findings aspromptly as possible

Have consistent and timely communication with team members and family members

Individual Family CommunityPrimary Secondary

Frequently reassess the residents' family caregivers stress and coping level to determine the appropriate level of support they require.

Increase resident's health status monitoring and communication by encouraging staff and caregivers to record complete assessment and information, and share with family members and other health care professionals in a timely manner.

Community environmental management and risk protection (NIC)*Collaborate with the community and city government to bring awareness of safety in the community. Propose changes to promote a safer environment, including senior pedestrian crossing signs, lights or speed bumps to reduce speed to ensure seniors' safety.

Initiate screening for health risks from the environment

Promote governmental policy to reduce specified risks

Assess environment for potential and actual risk

Notify agencies authorized to protect the environment of known hazards

Community StructuralPrimary

Contact appropriate government office to raise safety issue and lobby for lights and better signage to be installed at the crosswalk.

Collaborate with the community and city government to bring awareness of safety in the community.

Propose changes to promote a safer environment, including older adult pedestrian crossing signs, lights, or speed bumps to reduce speed to ensure older adults' safety.

Dementia management (NIC)*Create a more supportive environment for residents with dementia to assist with their daily activities and functioning. Increase staff collaboration with family members in planning the specific care for these residents.

Include family members in planning, providing, and evaluating care for residents with dementia

Provide specific workshops to address dementia for staff and family members to help manage caregiving to these residents

Individual Family CommunityTertiary

Nametags can have residents' room numbers printed to assist with room finding in the event the resident becomes lost. Room numbers to be included on the back of the nametag to ensure privacy.

Contact the Alzheimer's Society to arrange workshops for staff, family members, and residents.

Establish peer support programs for caregivers and residents with dementia.

Create specialized recreational activities for residents with dementia, such as art, music, and physical therapy.

Efficient and effective use of the resourcesAccording to residents, many are not properly informed about Homecare Services. They do not know what services are offered or how to access them.

Determine the appropriate health care service required to meet residents' needs

Consult and negotiate with family members and residents to determine the level of care needed

Monitor delivery of quality patient care to ensure cost-effectiveness

Individual Family CommunitySecondary

Have information sessions for residents about Homecare Services as soon as they move in.

Create a short and convenient FAQ sheet for residents and their families about Homecare Services.

Nurses and staff need to inform and promote Homecare Services, and teach residents how to effectively access those resources.

Orient patient/family/significant others to expectations of care.

Frequently reassess residents physically and psychosocially to determine the appropriate level of care they require.

Provide adequate education to the nursing/admissions staff.

Program development for support system enhancementInvite family and friends to visit and encourage family and friends to have more involvement. Create volunteer program to visit and interact with older adults.

Establish trusting relationship with family members

Encourage family to maintain positive relationship

Encourage relationships with individuals who have common interests and goals

Individual Family CommunityPrimary

Plan activities and invite family members to participate, such as a monthly cooking night where a resident contributes a recipe, does the shopping for the ingredients, and cooks. It can be under the coordination of a family member to promote family involvement. Provide appropriate division of tasks to accommodate differing levels of mobility.

Use some of the property garden to create a community garden to grow food that can be used in meals. This will give a sense of ownership in regard to meals. This intervention can be spearheaded by residents, staff, family members, or volunteers. It may be possible to obtain grants to defray the cost of setting up the garden.

Implement a volunteer program where volunteers can come and meet with residents who are at risk for social isolation on a one-on-one basis. Volunteers can be canvassed from the Valley Ridge community to promote community awareness of The Lodge and community involvement.

Different recreational activities, such as the theater and philharmonic, can be promoted. Residents will be provided with a list of theaters that offer discounted rates for older adults.

Organize and facilitate volunteer opportunities for residents. Connect interested residents with external support resources, such as telephone reassurance or friendly visiting program.

Program Evaluation

Intervention (NIC)Process (Implementation)Impact—Short TermImpact—Long TermInformation to Collect
Health education for staff and residentsProvide ongoing education for staff and residents for relevant health issues by inviting speakers and having information sessions. Conduct “train the trainer” sessions so that management can provide information sessions to the residents. Have a dietician come in to educate residents about snack management (i.e., when shopping, what they should buy to stock in their kitchenette that is healthy and appropriate if they have health issues). Create a FAQ sheet for residents regarding dietary services for when they return from the hospital or fall ill and cannot make it to the dining room for meals. Residents may not be aware of the complementary meal delivery in these situations.

Residents, families, and support staff gain more knowledge and care skills regarding a variety of chronic diseases.

Residents gain more knowledge regarding healthy eating.

Residents gain more knowledge regarding services offered by The Lodge to support them during times of illness.

Residents' health care increasedKey informant interviews, surveys, focus groups

Anxiety of caregivers

Dementia management Caregiver supportNametags can have residents' room numbers printed to assist with room finding in the event the resident becomes lost. Room numbers to be included on the back of the nametag to ensure privacy. Contact the Alzheimer's Society to arrange workshops for staff, family members, and residents. Establish peer support programs for caregivers and residents with dementia. Create specialized recreational activities for residents with dementia, such as art, music, and physical therapy.Residents, families, and support staff gain more knowledge regarding Alzheimer's disease (AD) Increased support to residents with AD and their caregiversDecreased caregiver sense of isolation Decreased caregiver stressObservational Key informant interviews, surveys, focus groups

Anxiety of caregivers

Community environmental management and risk protectionContact appropriate governmental office to raise safety issue and lobby for lights to be installed at crosswalk.Residents feel saferResidents will get outside moreObservational Interviews

Residents feel safer

Efficient and effective use of the resources CommunicationHave information sessions for residents about Homecare Services as soon as they move in. Create a short and convenient FAQ sheet for residents and their families about Homecare Services. Nurses and staff need to inform and promote Homecare Services, and teach residents how to effectively access those resources. Orient patient/family/significant others to expectations of care. Frequently reassess residents physically and psychosocially to determine the appropriate level of care they require. Provide adequate education to the nursing/admissions staff .More questions about Homecare Services will be asked

Increased use of Homecare Services resulting in slower decline of health

Residents are only admitted if the appropriate care levels can be provided for them.

Resident care levels will be adjusted as appropriate to match the level of care required

Key informant interviews with staff and residents, surveys
Program development for support system enhancementPlan activities and invite family, such as a monthly cooking night where a resident brings in a recipe, a group of residents do the shopping for the ingredients, and another group of residents do the cooking. It can be under the direction of a family member to promote family involvement. Appropriate division of tasks to accommodate differing levels of mobility. Use some of the property garden to create a community garden to grow food that can be used in meals. This will give a sense of ownership in regard to meals. This can be spearheaded by residents, staff, family members, or volunteers. It may be possible to obtain grants to defray the cost of setting up the garden. Encourage residents with balconies who are willing to grow herbs that can be used in meals to give a sense of ownership in regard to meals. Implement a volunteer program where volunteers can come and meet with residents who are at risk for social isolation on a one-on-one basis. Volunteers can be canvassed from the Valley Ridge community to promote community awareness of The Lodge and community involvement. Different recreational activities, such as the theater and philharmonic, can be promoted. Residents will be provided with a list of theaters that offer discounted rates for older adults. Organize and facilitate volunteer opportunities for residents. Connect interested residents with external support resources, such as telephone reassurance or friendly visiting program.

Increased involvement by family members

Increased involvement by residents

Volunteer program will be established

Increased social support networks

Decreased sense of isolation Increased sense of community

Increased resident sense of satisfaction due to new and different activities

Observed and reported increased involvement by family members; key informant interviews, surveys

Logic Model - Improving the Health and Wellness for Seniors Living in Assisted Care Facility

GoalTo identify, implement, and evaluate intervention strategies that will increase residents' health and wellness at the ACF through collaborative partnership.
TargetSenior citizens residing at the Lodge in City in a Western province of CanadaStaff, family members, community key stakeholders and health care decision makers.
ComponentsRelationship BuildingAdvocacyEducationHealth Care Services
Long-Term Objectives

-Long standing and trusting relationship established between residents and staff, and nursing students.

-Open communication between staff, residents, and students regarding all health and wellness needs.

-Increase awareness, involvement and rapport of community key stakeholders and health care decision makers in regard to residents' health and wellness needs.

-Creating new relationships with outside organizations and community members.

-Increase quality and quantity of health care services provided in the Lodge.

-Increase residents and staff awareness and knowledge regarding relevant health and wellness topics.

-Increase awareness of resources and services available to residents.

-Maintain and increase resident satisfaction with the health care services provision.

-Mitigate the effect of the residents' decline in physical and mental health status and the associated stigma.

Long-Term Indicators

-Positive feedback regarding the partnership between staff, residents and University nursing students.

-Residents state that they feel comfortable expressing all health concerns to staff, including issues related to dementia and Alzheimer's.

-Have changing needs of the Lodge communicated and advocated to the municipal and provinical government.

-Increased interactions between residents and members of the outside community.

-Increase in the number of health care staff hired by the Lodge to meet the residents' increasing needs, including the acquisition of a RN who is on site full time.

-Staff counsel residents on department specific key issues.

-Maintenance of information sessions and pamphlets on health care for residents.

-Increase in the bus transport range to include access to residents' preferred locations.

-Increase in education, support, and specific programming related to dementia, Alzheimer's, and other chronic diseases.

Short-Term Objectives

-Having another group of nursing students working with the Lodge in the coming year

-Implement volunteer programs for the Lodge.

-Accessing external funding, grants, and fundraising for establishment of new recreational activities to involve more residents.

-Addressing residents' concerns to the stakeholders such as pedestrian safety concerns.

-Exploring the cultural and artistic activities available in the City catered specifically for senior citizens.

-Implementation of information sessions and pamphlets on health care for staff and residents.

-Advocating for the increase of health care staff to accommodate the residents' changing needs.

-Continuing assessment of the residents' satisfaction of the health care services.

Short-Term Indicators

-Continue a working relationship between the Lodge and Faculty of Nursing at the University.

-Recruitment of five to ten volunteers.

-Obtain $5,000 to $10,000 of the external fund

-A safety measure, such as the installation of a rapid flashing beacon or a speed bump.

-Evidence of new recreational activities in the Lodge.

-Establishment of communication between live theater contacts, Life Enrichment Manager, and Resident Services Manager.

-Quarterly information sessions implemented.

-FAQ sheets on Homecare Services and dietary services printed and distributed to the residents.

-Annual surveys to indicate high level of satisfaction (≥ 90%) on health care services in the Lodge.

Resources

-Finances from the Lodge

-Municipal government

-Province Health Services

-Alzheimer's Society

-Social media

-University, Faculty of Nursing, and nursing students

-Government funding agencies and private funding sources

-Community members, including family members and friends

-Events coordinators for live theater companies in the City

Authors

Ms. Ballantyne-Rice, Ms. Chopp, Ms. Evans, Ms. Ho, Ms. Hsiung, Ms. Simon, and Ms. Wu are Second Year Nursing Students; and Dr. Donnelly is Professor, University of Calgary, Calgary, Alberta, Canada.

The authors have disclosed no potential conflicts of interest, financial or otherwise. The authors thank all of the managers at The Lodge, especially Jennifer Mattice and Cora McDonald; and acknowledge the support and contributions provided by all staff and residents of the Lodge.

Address correspondence to Tam Truong Donnelly, PhD, Professor, University of Calgary, PF 2234, 2500 University Drive NW, Calgary, Alberta, Canada T2N 1N4; e-mail: tdonnell@ucalgary.ca.

Received: November 12, 2015
Accepted: April 22, 2016
Posted Online: June 03, 2016

10.3928/00989134-20160531-03

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