Life In The Slower Lane

Here is the PICO analysis for the twentieth uploaded article:

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✅ PICO Analysis

Full Article Title:

A Systematic Review of Interventions to Change Staff Care Practices in Order to Improve Resident Outcomes in Nursing Homes

Type of Study:

Systematic review

Journal and Year:

PLOS ONE (2015); 10(11): e0140711

DOI: 10.1371/journal.pone.0140711

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P – Population

• Setting:
  • Long-term care settings, specifically nursing homes/residential aged care facilities
• Participants:
  • Nursing home staff targeted by interventions (e.g. nurses, personal care workers, allied health)
  • Indirectly: older residents in these facilities
• Study Inclusion Criteria:
  • Interventions delivered to ≥3 sites per group
  • Quantitative outcomes assessing change in staff behaviour or resident outcomes
  • Excluded if only attitudes, knowledge or satisfaction were measured 

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I – Intervention

• Nature of Intervention:
  • Broad range of interventions designed to change staff practices to improve resident outcomes
  • Interventions categorised by components:
    • Education materials
    • In-person training
    • Reminders (e.g. posters)
    • Audit and feedback
    • Mentoring/support
    • Champions
    • Team meetings
    • New policies/procedures
    • Organisational restructure
• Domains Covered:
  • Oral health
  • Hygiene and infection control
  • Nutrition
  • Pneumonia prevention
  • Depression management
  • Appropriate prescribing
  • Physical restraint reduction
  • Dementia behaviour management
  • Falls prevention
  • Quality improvement
  • Care philosophy/culture change
  • Other (e.g. elder abuse prevention, pain management) 

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C – Comparison

• Control Conditions:
  • Ranged from “usual care” to guideline-only or waitlist controls depending on the study
• Review Inclusion:
  • Only included RCTs or quasi-experimental studies with ≥6 sites total (≥3 per group), reducing confounding by site

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O – Outcomes

Primary Outcomes:

• Staff Behaviour Change:
  • Whether targeted staff care practices were actually modified
• Resident Outcomes:
  • Direct clinical outcomes (e.g. pressure ulcers, falls, depression, nutrition, hospitalisation)

Secondary/Indirect Outcomes:

• Staff Indirect Outcomes:
  • Job satisfaction, burnout, retention, absenteeism
• Resident Indirect Outcomes:
  • Quality of life, satisfaction, functional ability

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Outcome Classification

• Person-centred outcomes: Frequently attempted but inconsistently improved; more likely to improve in studies with direct, simple clinical tasks (e.g. oral hygiene) than broader culture change programs
• Process outcomes: Commonly targeted (e.g. reduced restraint use, improved prescribing), with success often dependent on feasibility and complexity of the intervention
• Health system outcomes: Mixed; limited reductions in hospitalisations, falls or other distal outcomes; few studies reported cost-effectiveness 

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Summary Conclusion

This comprehensive systematic review analysed 63 unique studies across 12 care domains, revealing that no single intervention component or combination reliably led to staff behaviour change or better resident outcomes. Interventions targeting specific, discrete practices (e.g. physical restraint use, oral hygiene) were more likely to succeed than those aiming at global practice changes (e.g. philosophy of care or quality improvement). Studies using behaviour change theory and clear program logic showed greater success, but few articulated this explicitly. Barriers included staff turnover, workload, lack of training resources, and system-level constraints. The review highlights that changing staff practice is feasible but complex, and suggests that future interventions should be multifaceted, theory-driven, and designed with clear, context-sensitive implementation strategies .

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