Component | When delivered | By whom | Description |
---|---|---|---|
I. Environmental and Policy Assessment | Beginning of the study (during the first month of study); at completion of the implementation | Fam-FFC research nurse with unit champions; recommendations for change discussed with administration | Possible modifications include development of policies for: labeling glasses/hearing aids, uninterrupted quiet times, FCG involvement in rounds, and bedside white boards to promote FCG/patient communication with the interdisciplinary team; and access to hearing amplifiers, magnifiers, activity cart/ supplies; mobility devices; noise trackers; snacks and fluids |
II. Staff Education and Training (delivery options include: instructor-led PowerPoint presentations, web-based training, and one on-one review) | Beginning of the study (during the first 2 months of study) | Fam-FFC research nurse on intervention units; alternate nurse on control units | Content includes: • dementia, delirium, functional decline etiology, cognitive and functional assessment, patient communication, and evidence-based approaches to prevent cascade iatrogenesis • hospital experience and responses of the patient/family • function-focused care (rationale, incorporating FFC into routine care, specific techniques/ equipment, safety considerations, goal setting/ discharge planning) • partnerships with families (assessment of preferences, active listening, information-sharing, care planning, promoting advocacy and patient/ family engagement in decision-making, discharge planning) |
III. FamPath Care Pathway | During the 12 months of implementation | Fam-FFC research nurse | Components of FamPath include: • information on the admitting condition, diagnostics, and treatment • family/patient education: provided in lay terms (cueing and motivating techniques, support of physical activity, meals, cognitive stimulation, behavioral support, and safety) linked to joint FCG/ nurse assessment (baseline cognition, physical function and social profile) • jointly developed bedside goals [69] and treatment plans (updated daily) and discharge checklist • coaching of primary nurse to communicate and provide a copy of the FamPath plan to post-acute providers • post-acute follow-up to provide ongoing education and modification of the function-focused care plan (within 48 h of discharge, weekly telephone calls for a total of 7 additional weeks, then monthly for 4 months) |
IV. Ongoing Training and Motivation of Nursing Staff | Following initial education of the staff; during 12 months of implementation | Fam-FFC research nurse mentors the unit champions and nursing staff | Components include: • assistance to champions and nurses is provided on consented patients to: (a) complete the physical capability assessments [70], (b) establish and update FFC goals with input from FCGs/patients (Goal Attainment Scale) [69] and (c) develop a care plan with FCG/ patient addressing factors that impede FFC (e.g., acute illness, sedation, pain, fear/anxiety, pain, apathy, NPS, depression) • support of the unit champions to mentor nursing staff (RN, LPN, nursing assistants) includes: (a) role-modeling; (b) highlighting staff role models and positive opinion leaders; (c) garnering support by sharing success stories with nursing council and administration; (d) maintaining Fam-FFC bulletin board with updates /educational reinforcement; and (e) observing nursing staff during care interactions using the Function Focused Care Behavior Checklist [71], providing feedback to staff |