Hawes, 1997 [33] |
SNFs |
254 SNFs |
2 resident cohorts (>2000); 10 states |
Quasi-experimental probability-based sample |
Use of physical restraints and indwelling catheters; Use of advanced directives; Resident participation in activities and toileting programs for bowel incontinence |
Decreased use of physical restraints and indwelling catheters; Increased use of advanced directives; Increased resident participation in activities and toileting programs for bowel incontinence |
Achterberg, 2001 [39] |
Dutch NHs |
10 NHs; 18 wards |
Interviews with residents and staff |
Quasi-experimental |
Quality of coordination |
Improvement in care coordination post RAI implementation |
Lee, 2003 [40] |
Midwest NHs |
3 NHs |
Observation, interview, medical record review |
Mixed methods |
Process based costing of care planning in NHs |
Calculating directs costs for care planning is possible. Data collection for costs is based on a process map. |
Tauton, 2004 [41] |
Midwest NHs |
3 NHs |
Semi-structured interview, observation, chart audit |
Mixed methods/case reports |
Care planning process |
Facilities differed in their approaches; care linked to other methods of communication and records. |
Piven, 2006 [42] |
SNFs |
2 SNFs; 4 MDS coordinators |
Staff interviews with MDS coordinators, administration, nursing social work, activities, rehabilitation, dietary, environmental services |
Comparative multiple case study |
MDS Coordinators’ patterns of relationships and association with care processes |
Positive MDS patterns generated new information flow, good connections, cognitive diversity contributed to positive assessment and care planning. Negative MDS patterns had opposite effect |
Bott, 2007 [43] |
NHs in Mid-west |
Random sample-107 NHs; 437 staff |
Staff interviewed: MDS coordinators; assistant coordinators; social services directors, activities directors, dietary directors; other staff (medical records, LVN, therapists, nursing assistants). |
Mixed methods |
Process-based costing; Indicators for data envelopment analyses (DEA) |
2 NHs were most efficient (fewer deficiencies, less time spent in care plan meetings); Less efficient NHs spent 2 to 5 more time in CP meetings and no increase in quality or efficiency. SNFs less likely to be efficient |
Colón-Emeric, 2007 [44] |
SNFs |
4 SNFs; 360 staff |
Field observations; shadow encounters; in-depth interviews |
Comparative multiple case study |
Relationship between staff connections and care planning process |
Greater staff connections associated with higher care plan specificity (tailored) and innovation |
Adams-Wendling, 2008 [45] |
NHs in Mid-west |
Purposeful sample of 96 residents’ care plans |
Care plan documents |
Retrospective case review |
Care plan content |
Translation issues included: CP length; content (routine practices and redundant interventions); variability in language use; fragmented care plan and poor location |
Dellefield, 2008 [46] |
AANAC national conference |
24 RN MDS coordinators |
Focus groups; questionnaires |
Mixed methods |
Description of MDS Coordinator work in organizational context |
Structural, technical, cultural, strategic organizational dimensions influenced work of MDS coordinator |
Taunton, 2008 [47] |
NHs-Kansas, Missouri |
107 random sample NHs; 508 staff members |
Telephone interview, OSCAR data |
Mixed methods (Correlational model generation-model selection design) |
Generate empirically supported model of care planning integrity |
Care planning integrity demonstrated through direct relationships with coordination, integration, quality; indirect relationships through integration with IDT team and restorative perspective. |
Straker, 2008 [48] |
NHs Ohio |
997 NHs; 202 respondents |
Stratified random sample NHs; random sample staff |
Descriptive |
Processes used to complete MDS |
MDS process is time intensive, involves various staff, requires training, manual is valuable. |
Lee, 2009 [49] |
NHs-Kansas, Missouri |
107 NHs; 437 staff |
Staff interviews: MDS coordinators; assistant coordinators; social services directors, activities directors, dietary directors; medical records, LVN, therapists, nursing assistants |
Mixed methods-Interviews and regression and DEA analyses |
Efficiency of assessment process; Average cost and quality of care plan |
NHs used different combinations of staff to complete care plans; Plans/week varied 10 fold; average cost varied 8 fold; 47% had no care plan deficiency in most recent survey. |
Kontos, 2009 [50] |
NHs in Central Canada |
26 personal support workers (PSW)s; 9 supervisors |
Focus groups and semi-structured interviews |
Focus groups and interviews |
Decision-making and care practices of PSWs in relation to RAI/MDS process |
Assessment information known by PSWs not captured in RAI/MDS categories or communicated to interdisciplinary team. Factors included lack of access to computerized records, low status, and poor inter-professional collaboration |
Lindsay Bratton-Mullins, 2010 [14] |
Historic and current nursing text books |
7 textbooks |
Text in textbooks on care plan education |
Phenomenological analysis |
Care plan as indicator of change in nursing science instruction |
Care plan development used to teach critical thinking skills to RN students |
Colon-Emeric, 2010 [51] |
SNFs |
8 SNFs; 958 staff |
Field observations; direct observation; and interviews |
Content analysis of in-depth multiple-case study |
Purpose and utility of regulations (including RAI/MDS) |
Increased mindful behaviors in resident centered SNFs; Reduced mindful behaviors in cost-focused culture due to regulation |