A systematic review of interventions to change staff care practices in order to improve resident outcomes in nursing homes

Low, Lee-Fay, Fletcher, Jennifer, Goodenough, Belinda, Jeon, Yun-Hee, Etherton-Beer, Christopher, MacAndrew, Margaret and Beattie, Elizabeth (2015) A systematic review of interventions to change staff care practices in order to improve resident outcomes in nursing homes. PLoS One, 10 11: . doi:10.1371/journal.pone.0140711

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Author Low, Lee-Fay
Fletcher, Jennifer
Goodenough, Belinda
Jeon, Yun-Hee
Etherton-Beer, Christopher
MacAndrew, Margaret
Beattie, Elizabeth
Title A systematic review of interventions to change staff care practices in order to improve resident outcomes in nursing homes
Journal name PLoS One   Check publisher's open access policy
ISSN 1932-6203
Publication date 2015-11-11
Sub-type Article (original research)
DOI 10.1371/journal.pone.0140711
Open Access Status DOI
Volume 10
Issue 11
Total pages 60
Place of publication San Francisco, United States
Publisher Public Library of Science
Collection year 2016
Language eng
Formatted abstract

We systematically reviewed interventions that attempted to change staff practice to improve long-term care resident outcomes.


Studies met criteria if they used a control group, included 6 or more nursing home units and quantitatively assessed staff behavior or resident outcomes. Intervention components were coded as including education material, training, audit and feedback, monitoring, champions, team meetings, policy or procedures and organizational restructure.


Sixty-three unique studies were broadly grouped according to clinical domain—oral health (3 studies), hygiene and infection control (3 studies), nutrition (2 studies), nursing home acquired pneumonia (2 studies), depression (2 studies) appropriate prescribing (7 studies), reduction of physical restraints (3 studies), management of behavioral and psychological symptoms of dementia (6 studies), falls reduction and prevention (11 studies), quality improvement (9 studies), philosophy of care (10 studies) and other (5 studies). No single intervention component, combination of, or increased number of components was associated with greater likelihood of positive outcomes. Studies with positive outcomes for residents also tended to change staff behavior, however changing staff behavior did not necessarily improve resident outcomes. Studies targeting specific care tasks (e.g. oral care, physical restraints) were more likely to produce positive outcomes than those requiring global practice changes (e.g. care philosophy). Studies using intervention theories were more likely to be successful. Program logic was rarely articulated, so it was often unclear whether there was a coherent connection between the intervention components and measured outcomes. Many studies reported barriers relating to staff (e.g. turnover, high workload, attitudes) or organizational factors (e.g. funding, resources, logistics).


Changing staff practice in nursing homes is possible but complex. Interventionists should consider barriers and feasibility of program components to impact on each intended outcome.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ
Additional Notes Article # e0140711

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Nursing, Midwifery and Social Work Publications
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Created: Tue, 22 Mar 2016, 10:48:59 EST by Natalie Cowley on behalf of School of Nursing, Midwifery and Social Work