Research in long-term care is often hard to come by, as my colleague Elizabeth Newman noted last month. But a group of experts from Colorado is attempting to better understand this phenomenon, and they are offering some important insights into how to increase such academic explorations in the skilled care community.
Remember, folks, the next great solution to C. Diff outbreaks, better palliative care or even a way to cut down on even a few of the night time incontinence calls could be just around the corner — but only if the research is done … with your help.
You’re probably already familiar with some of the impediments that might be keeping providers and other stakeholders from participating in research. Nursing facility workers are plenty busy and can have a hard time finding extra minutes to contribute. Plus, positions often turnover frequently. Residents, meanwhile, are often grappling with complex medical issues coupled with unique ethical considerations, and that can also make them hesitant to take part in research.
Wanting to better understand the roots of some of these barriers, Colorado School of Public Health Ph.D. candidate Cynthia Drake and colleagues recently interviewed nursing home stakeholders from four distinct groups: providers (i.e., doctors, nurse practitioners), frontline staff (RNs, CNAs), administrative leadership (directors of nursing, administrators), and residents and their families. They found a universal willingness across those groups to participate in research, but also a need to engage some of the barriers that are helping to perpetuate this research gap.
“Collaborating with researchers and allowing your facility to participate in research is worth it,” Drake told me when asked for the key takeaway from her study, which was published last month in the Journal of Post-Acute and Long-Term Care Medicine. “We found that each stakeholder group that we engaged — providers, frontline staff, administrative leadership, residents and family members of residents — were supportive of, and interested in, facilitating research.”
Drake shared that often perceived “barriers” to nursing facility research participation are more accurately described as “challenges” that can be overcome by the industry. For instance, frontline nursing home staffers and administrators were often concerned about the time burden that research might place on staff and garnering buy-in from employees to participate in such activities. Drake believes that researchers must design protocols that are more mindful of staffers’ time, with built-in plans to periodically “re-engage” and “re-educate” them on those protocols, and assess the study’s progress.
“Staff must balance competing priorities and have highly variable responsibilities in their work. Staff turnover rates and siloed roles make it difficult to sustain the care teams’ involvement in research activities,” Drake wrote in the study. Those barriers, coupled with the fact that most nursing facilities do not reward their employees for research participation, all contribute to an environment that is “unconducive to research,” in a time when the need for solid post-acute care research is only going to grow as the population ages.
Drake and company put the onus on researchers to “adapt to this challenging environment” in their study approach and design. But, certainly, it seems that administrators and directors of nursing could help make researchers’ work a little easier by finding ways to reward their staffs for participating in studies, building time into busy schedules to allow for such activities, and strengthening ties with local academic institutions to explore some of their most pressing concerns (polypharmacy, care transitions, mental health, chronic pain, urinary tract infections and quality of life came up most frequently in surveys, according to Drake).
Making some of these sacrifices might be painful for your facility in the short-term. But I have to figure the long-term payoff will be worth it once those research insights start trickling in and begin to transform the care you provide on a daily basis.
Follow Staff Writer Marty Stempniak @MStempniak.