No population of older adults is more at risk of losing independence than those in institutional settings. Many factors in resident care and management increase dependence unnecessarily, particularly in the areas of incontinence care and physical restraint management. Although interventions have been developed to address these issues, research has shown that a fundamental stumbling block to decreasing resident dependence in these and other areas is the management of nursing aides. In fact, research demonstrates that residents are often neglected and even systematically reinforced for dependency by nursing aides, who provide over 90% of direct resident care in this country's nursing homes. The purpose of this project is to develop and test a staff management system that will change how nursing aides deliver daily care to residents, to ensure that interventions designed to decrease dependence are consistently implemented. This staff management system will be computerized and is based on principles of statistical quality control widely used in industry. The investigators have already developed and tested interventions in the areas of incontinence and physical restraint management. This project will build on these intervention trials by documenting independent functioning benefits to nursing home residents, and then incorporating these interventions into a computerized statistical quality control management system. The project is divided into three phases. In Phase I, urinary incontinence and physical restraint management and exercise protocols currently under investigation will be further refined to document resident independent functioning benefits. These protocols will be translated into computerized management programs that should make the protocols usable within normal nursing home settings. This management program will be pilot tested during Phase II in preparation for a controlled field test, that will take place in Phase III. In Phase III, efforts will be made to implement and evaluate the urinary incontinence and restraint management protocols in two nursing homes using only indigenous staff to provide all resident care. Improvements in resident independent functioning in areas related to incontinence and physical restraint management are expected in all phases of research. A pilot research project to be coordinated with this proposal will develop personal grooming intervention protocols that could be the third clinical focus area for the management system to be evaluated in this proposal.
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