Table 5 Summary of Key Categories Affecting EIT-4-BPSD Program Implementation within RE-AIM Framework

Reach

Family

Family as essential member of care team

I learn a lot about my residents from families. (3–308)

Staff

Interdisciplinary team members

Reach out to all of your team members, not just nursing. Everyone can help. (2–306)

Organizational

Nursing home motivation for study engagement

Although we have many years of experience working with this population, (there were) the failed attempts to get results... (welcomed) a new approach and maybe some education. (3–314)

Effectiveness

Staff Outcomes

Changes in staff behaviors

We also have staff doing things with versus just for residents and we are trying to match activities with resident preferences…nursing assistants are doing more teaching and cueing. (1–108)

Changes in staff attitudes

We are going towards a prevention mindset to identify and eliminate triggers. It helped them [staff] look at behavior in a different way. (3–122)

Staff empowerment

Staff have gotten excited about effectiveness of non-pharmacologic interventions, [they] feel empowered. (1–202)

Environmental Outcome

Changes to the physical environment to promote function and well-being

Definitely focusing more on personal preferences of patients. We have also done things like “soften up the environment.” (1–108)

Resident Outcome

Decrease in BPSD

Our residents’ behaviors have gone down since the study. (3–314)

Adoption

Utility of EIT Resources

Brainstorming exercise

The brainstorming was really helpful as it helped us to see things in a different way. (2–112)

DICE model (Describe, Investigate, Create, Evaluate)

They learned to use DICE and used this to figure out the situation and intervene. (2–114)

Nursing Home Toolkit

Nursing home toolkit website...it was helpful, but we did not utilize too much - enjoyed sundowning tidbit. (2–304)

Tidbits

We had education sessions using the weekly tidbits, very informal, positive response… (3–310)

Staff education

I think education is really the most important thing. (2–210)

Staff contests

The contests were very helpful and got the staff motivated and engaged in providing behavioral interventions to residents. (3–122)

Behavioral observations

It was a really nice way to give peer-peer observations… first couple of times I found it difficult because I thought I could not intervene, but I learned I could it gave an opportunity to model good responses. It was a real-life example of how to model behavior. (3–310)

Huddles

…our huddles [are] where we talk about specific residents, their behaviors and what we can do to change their behaviors. (3–314)

Stakeholder meetings

Stakeholder meeting… we came to monthly meeting open to all staff, much more effective then random sitting next to one another but opportunity for everyone to be equals when approaching this topic. (2–304)

Interventionist as role model

…really liked…having the research nurse there and doing hands on activities with the staff. (1–108)

Care plan review

It was very eye-opening…It gave us a chance to look and go through and make sure care plans are accurate. We have written more customized care plans and moved away from check boxes. Extra time to look at and reassess to improve was helpful (3–310)

Environment and Policy Assessment

…we do have corporate office, and a lot of the policies are handed to the site so you can make suggestions but it is not something you can anticipate a change…so you don’t want to spend time on it. (2–304)

Implementation

Barriers

Physical environment

The environment was a little bit of a barrier for us-no area for open walking. (2–112)

Nursing home regulations

Worried about HIPPA and getting staff to look at and use this material. (1–106)

Finances

Many restraints an issue- not able to get finances. (3–308)

Competing demands

I was promoted which gave me more responsibilities, so I did not have as much time to focus on (implementation) goals. (3–310)

Staffing levels/turnover

We were working with short staff so a lot of the behaviors they were likely not charting because we were short. (3–314)

Facilitators

Motivators for change

I think in the beginning we were having a lot of residents with behavioral disturbances and we did not know how to non-pharmacologically manage those residents – that was our largest strive at the time. (2–210)

Manager/leadership engagement

The manager dedication, house supervisor dedication, and the interventionist following through with what the study offered were all factors to the success of the study. (3–128)

Staff buy-in

Getting buy-in from staff outside of the stakeholder group. They are all interested, they wanted to learn. The staff genuinely care about our residents. (2–306)

Access to recreational activities for residents

We made major inroads by establishing that we needed an activities room for the residents. A place that they could go to and engage in some of the activities. We now have that room! (1–106)

Care Process Adaptations

Staff-staff and leadership communication

Goal number one, we were in the process, but this put an emphasis on ensuring that all staff had access to information. This has made information more accessible. (3–310)

Care planning process

We started a new behavioral care planning process. We meet weekly to take a deeper dive into why behaviors are occurring, identify and eliminate triggers. (2–306)

Quantity and quality of resident recreational activities

Cutting down on psychotropics. Increasing activities. We have more resident focused groups now like a men’s group. For the women we had a mother/daughter tea... (2–306)

Formal process for staff engagement

December in-service was highest attended, very physical in-service where there was competition…they were so engaged…and part of that was that they had to say something important…There was acceptance of time spent… It was worth it. (2–304)

Maintenance

Future Planning

Specific organizational goals

[This study is] an attempt for our organization to improve the well-being of our residents through specific organizational goals. (3–308)

Remain on Tidbit list

We want to keep getting the tidbits. (2–120)

Commit to provide in-services

Way to continue in-services…Choose 3 staff to commit to provide in-services. Pick a topic –give open forum to follow-up on the education that received –very positive to continue with all the staff. (2–304)

Plan for continued meetings

... we still keep the once a month stakeholder meeting. (2–304)

Measures of success

... we started out thinking about measurement and how to improve our quality indicators, after consulting it seemed that we changed to how we can increase moments of joy as measurement of success (3–308)