{"title":"长者护理院如何推行质素改善策略及评估成效？一个系统的搜索和叙述评论","authors":"Fiona Cowdell, Hannah Harvey, Judith Dyson","doi":"10.1111/opn.70036","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>We conducted a systematic search and narrative review of quality improvement in care homes. Our aim was to examine how quality improvement strategies have been adopted and how impact has been assessed in care homes for older people.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Following PRISMA guidelines, we conducted systematic searches of the electronic databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, PsycINFO and Applied Social Sciences Index & Abstracts (ASSIA) (2019–2024). We replicated the search strategy of a previously published review. Three co-authors undertook selection and data extraction.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Forty-four articles were included describing varied stages of quality improvement initiatives in care homes. The United States produced the largest number of studies. Quality improvement strategies were often poorly reported. Included papers reported stages of quality improvement from inception to evaluation. Most aimed for improved clinical outcomes, mainly those subject to external scrutiny. Few studies reported impact robustly. Quantitative measures, surveys and qualitative data were reported alongside staff-reported changes. There was no evidence of sustained improvement. There is some evidence of the use of theories, models and frameworks usually associated with implementation and knowledge mobilisation.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Current improvement practice is inconsistent and having limited impact.</p>\n </section>\n \n <section>\n \n <h3> Implications for Practice</h3>\n \n <p>We recommend any initiative to enhance resident experience and outcomes should involve establishing a project team, moving away from a deficit model, prioritising areas for improvement, identifying best practice, deciding how to measure improvement, understanding the challenges to best practice, co-designing strategies to effect change, sustaining the improvement, sharing learning and providing clear, detailed and accessible reporting.</p>\n </section>\n </div>","PeriodicalId":48651,"journal":{"name":"International Journal of Older People Nursing","volume":"20 5","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/opn.70036","citationCount":"0","resultStr":"{\"title\":\"How Have Quality Improvement Strategies Been Adopted and How Has Impact Been Assessed in Care Homes for Older People? 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Three co-authors undertook selection and data extraction.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Forty-four articles were included describing varied stages of quality improvement initiatives in care homes. The United States produced the largest number of studies. Quality improvement strategies were often poorly reported. Included papers reported stages of quality improvement from inception to evaluation. Most aimed for improved clinical outcomes, mainly those subject to external scrutiny. Few studies reported impact robustly. Quantitative measures, surveys and qualitative data were reported alongside staff-reported changes. There was no evidence of sustained improvement. 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How Have Quality Improvement Strategies Been Adopted and How Has Impact Been Assessed in Care Homes for Older People? A Systematic Search and Narrative Review
Introduction
We conducted a systematic search and narrative review of quality improvement in care homes. Our aim was to examine how quality improvement strategies have been adopted and how impact has been assessed in care homes for older people.
Methods
Following PRISMA guidelines, we conducted systematic searches of the electronic databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, PsycINFO and Applied Social Sciences Index & Abstracts (ASSIA) (2019–2024). We replicated the search strategy of a previously published review. Three co-authors undertook selection and data extraction.
Results
Forty-four articles were included describing varied stages of quality improvement initiatives in care homes. The United States produced the largest number of studies. Quality improvement strategies were often poorly reported. Included papers reported stages of quality improvement from inception to evaluation. Most aimed for improved clinical outcomes, mainly those subject to external scrutiny. Few studies reported impact robustly. Quantitative measures, surveys and qualitative data were reported alongside staff-reported changes. There was no evidence of sustained improvement. There is some evidence of the use of theories, models and frameworks usually associated with implementation and knowledge mobilisation.
Conclusion
Current improvement practice is inconsistent and having limited impact.
Implications for Practice
We recommend any initiative to enhance resident experience and outcomes should involve establishing a project team, moving away from a deficit model, prioritising areas for improvement, identifying best practice, deciding how to measure improvement, understanding the challenges to best practice, co-designing strategies to effect change, sustaining the improvement, sharing learning and providing clear, detailed and accessible reporting.
期刊介绍：
International Journal of Older People Nursing welcomes scholarly papers on all aspects of older people nursing including research, practice, education, management, and policy. We publish manuscripts that further scholarly inquiry and improve practice through innovation and creativity in all aspects of gerontological nursing. We encourage submission of integrative and systematic reviews; original quantitative, qualitative, and mixed methods research; secondary analyses of existing data; historical works; theoretical and conceptual analyses; evidence based practice projects and other practice improvement reports; and policy analyses. All submissions must reflect consideration of IJOPN''s international readership and include explicit perspective on gerontological nursing. We particularly welcome submissions from regions of the world underrepresented in the gerontological nursing literature and from settings and situations not typically addressed in that literature. Editorial perspectives are published in each issue. Editorial perspectives are submitted by invitation only.
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