THE ROLE OF FACILITATION IN SUSTAINABILITY OF A DEMENTIA TRAINING PROGRAM IN RURAL LONG-TERM CARE HOMES
Bibliographic record
Abstract
Simple dissemination is not effective in sustaining change, thus, other implementation strategies are required. We examined the relationship between facilitation and the sustainability of a dementia-specific behavioural training program (Gentle Persuasive Approaches; GPA) in rural LTC homes. Four focus groups with nursing aides (NAs) and 17 interviews with Formal Leaders (Directors of Care, Administrators), Clinical Nurse Leaders (CNLs; role includes leadership, education, mentoring), Registered Nurses, and GPA Coaches were completed in five LTC homes in a retrospective study. Document reviews, direct observation, and 15 semi-structured interviews with staff in all departments were completed in two LTC homes in a prospective (15 month) study. A continuum of low, medium, and high sustainability homes emerged. In low sustainability homes, facilitation was done by informal facilitators (NAs, GPA Coaches, and staff in other departments) but not formal leaders. In medium sustainability homes, facilitation was completed by informal facilitators and a CNL. Leadership in these homes verbally supported the program but their actions did not consistently reflect this and the CNL’s effectiveness was limited due to weaker leadership. In high sustainability homes, facilitation by formal leaders and informal facilitators occurred regularly and was higher in quality. The CNL was a key factor in the sustainability of the program in the high sustainability home, combined with the formal leader who had strong facilitation and leadership skills. The CNLs built relationships and problem solved. CNLs who had credibility, were respected, and used appropriate facilitation skills had a positive influence on the sustainability of the GPA program.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.021 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".