Life In The Slower Lane

Here is the standardised PICO analysis for the fortieth uploaded article:

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Full Title

Enablers and barriers to implementing care quality improvement program in nursing homes in China

Authors: Yinan Zhao, Lulu Liao, Hui Feng, Huijing Chen, Hongting Ning

Journal: BMC Geriatrics, 2021; 21:532

DOI: 10.1186/s12877-021-02488-0

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Type of Study

Qualitative descriptive study guided by the Theoretical Domains Framework (TDF)

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PICO Summary

Population (P)

• Nursing home staff in China
  • 8 nursing homes across four cities (Changsha, Xiangtan, Zhuzhou, Yueyang)
  • 8 nurse managers, 50 clinical nurses, 64 nursing assistants
• Inclusion: nurse managers with ≥5 years’ management experience, clinical nurses with ≥3 years’ clinical experience, and nursing assistants with qualifications and ≥3 months’ experience

Intervention (I)

• Pre-implementation analysis of a Quality Improvement (QI) program modelled on the Australian Aged Care Clinical Mentoring (ACCM) framework
• ACCM includes:
  • Clinical mentoring by senior nurses
  • Evidence-based care improvement
  • Training, feedback, and performance evaluation
  • Use of champions and support systems

Comparison (C)

• No formal control group
• Comparison between participant experiences across different stakeholder levels and roles

Outcomes (O)

Enablers (facilitators of implementation):

1. Organisational support – including rewards, managerial buy-in, flexible training delivery
2. Evidence-based practice ability – nurses searched for solutions and felt confident with knowledge
3. Proactivity and motivation – among nurses especially, driven by personal interest or belief in professional growth
4. Supervision and feedback – including periodic assessment and the potential role of senior nursing assistants as site champions

Barriers:

1. Low educational background of nursing assistants – literacy and skills deficits impacted learning and care delivery
2. Role confusion or resistance to hierarchy – staff struggled with leader-subordinate roles
3. Resistance to change – entrenched habits, belief current practice was “good enough”
4. Lack of job motivation – some saw work as routine, lacked intrinsic motivation
5. Organisational constraints – limited funding, staffing shortages, high turnover, no time for structured training

These findings were mapped to the 12 TDF domains including “beliefs about capabilities,” “social/professional role,” “environmental context,” “emotion,” and “memory/attention/decision processes” .

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Findings Summary

This study provides one of the first TDF-informed qualitative investigations of implementing a QI mentoring model in Chinese nursing homes. It underscores the need for:

• Organisational investment in infrastructure and training
• Flexible training approaches (e.g. online/offline, simplified manuals)
• Empowerment of site champions
• Strategies to build motivation and identity among nursing assistants

The findings offer critical insights for adapting Western-originated quality frameworks (like ACCM) into culturally and structurally distinct contexts like Chinese aged care.

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