Effectiveness of staffing models in residential, subacute, extended aged care settings on patient and staff outcomes

Hodgkinson, Brent, Haesler, Emily J., Nay, Rhonda, O'Donnell, Megan H. and McAuliffe, Linda P. (2011) Effectiveness of staffing models in residential, subacute, extended aged care settings on patient and staff outcomes. Cochrane Database of Systematic Reviews, 6: CD006563.1-CD006563.27.

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Author Hodgkinson, Brent
Haesler, Emily J.
Nay, Rhonda
O'Donnell, Megan H.
McAuliffe, Linda P.
Title Effectiveness of staffing models in residential, subacute, extended aged care settings on patient and staff outcomes
Journal name Cochrane Database of Systematic Reviews  (ERA 2012 Listed)    (ERA 2010 Rank A*)   Check publisher's open access policy
Publication date 2011-06-15
Sub-type Review of research - research literature review (NOT book review
DOI 10.1002/14651858.CD006563.pub2
Issue number 6
ISSN 1469-493X
Start page CD006563.1
End page CD006563.27
Total pages 27
Place of publication Oxford, United Kingdom
Publisher John Wiley & Sons
Collection year 2012
Language eng
Formatted abstract Background
A key concern for managers and nurse administrators of healthcare settings is staffing. Determining and maintaining an appropriate level and mix of staff is especially problematic for those working in the long-term aged-care sector, where resident needs are complex and recruitment and retention of staff is challenging.

Objectives
To identify which staffing models are associated with the best patient and staff outcomes.

Search strategy
We searched the Effective Practice and Organisation of Care (EPOC) Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Abstracts of Reviews of Effectiveness (DARE) in The Cochrane Library and the databases MEDLINE, EMBASE, Ageline, CINAHL, and Dissertation abstracts. We also handsearched the reference lists and bibliographies of all retrieved articles.

Selection criteria
This review considered interrupted time series studies and studies with concurrent control designs of care staff or residents of residential or subacute or extended aged-care settings that evaluated the effectiveness of staffing models and skill mixes on resident and care staff outcomes.

Data collection and analysis
Two review authors critically appraised all studies that were retrieved based on the screening of titles and abstracts according to the EPOC Group's data collection checklist.

The same two review authors independently extracted and summarised details of eligible studies using the data abstraction form developed by EPOC.

Main results
We included two studies (one interrupted time series and one controlled before-and-after study); both evaluated a primary-care model compared with a either a team-nursing model or a usual-care model. The primary-care model was found to provide slightly better results than the comparator for some outcomes such as resident well-being or behaviour. While nursing staff favoured the primary-care model in one study, neither study found significant improvements in staff outcomes using the primary model compared with the comparator. One study evaluated the uptake of the primary-care model within their facilities and found incorporation of this model into their practice was limited.

Authors' conclusions
Apart from two small studies evaluating primary care, no evidence in the form of concurrently controlled trials could be identified. While these two studies generally favour the use of primary care, the research designs of both ITS and CBA studies are considered prone to bias, specifically selection and blinding of participants and assessors. Therefore, these studies should be regarded with caution and there is little clear evidence for the effective use of any specific model of care in residential aged care to benefit either residents or care staff. Research in this area is clearly needed
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Art. No.: CD006563, pp. 1-27

Document type: Journal Article
Sub-type: Review of research - research literature review (NOT book review
Collections: Official 2012 Collection
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Created: Thu, 07 Jul 2011, 14:48:00 EST by Vicki Percival on behalf of School of Nursing and Midwifery