RECONSTRUCTING CARE PROCESSES IN NOVA SCOTIA LONG-TERM-CARE HOMES: A CONSTRUCTIVIST GROUNDED THEORY STUDY
Bibliographic record
Abstract
Background: The complex medical and social needs of long-term care (LTC) residents in Nova Scotia continue to challenge the existing care processes. Implementing the international resident assessment instrument long-term care facility (InterRAI LTCF) tool and software has not adequately met the care expectations of residents and their families. This shortfall highlights a critical gap in the alignment between the technological solution and the personalized care required by this population. Purpose: The purpose of this constructivist grounded theory study was to provide an in-depth understanding of the care processes involved in using the InterRAI LTCF tool for quality care improvement from the perspective of LTC residents, substitute decision-makers, and nurses. To achieve this purpose, the study was guided by the following objectives: a) Describe the processes of care involved in using the InterRAI LTCF tool at the point of care in LTC homes; b) identify problematic areas and potential solutions in care processes involving the use of the InterRAI LTCF tool; and, c) develop a substantive theory, in collaboration with residents, substitute decision-makers, and nurses, that explains how to improve care provision using the InterRAI LTCF tool for consistent health outcomes for the residents. Research Design: The constructivist grounded theory (CGT) methodology informed the exploration of different perspectives including LTC residents, substitute decision-makers, and nurses, focusing on improving the quality of care provided with the InterRAI LTCF tool. CGT builds on iterative collection and analysis of data, supporting an inductive process of theory formation. Sample and Setting: The study sample included 34 participants (residents, substitute decision-makers, and nurses) from eight LTC homes under the same organization in Nova Scotia. Methods/Procedure: The data collection occurred between October 2022 and April 2023, following research ethics approval from the care home and the University of Saskatchewan ethics board (REB 3490). A total of 34 participants participated in 38 semi-structured, open-ended, face-to-face interviews completed on Zoom and in-person, and guided by a flexible interview guide. The researcher audio-recorded the interviews with the participants' consent. A third-party transcriptionist transcribed the interviews verbatim, which were read for accuracy and organized in NVivo 12 software for analysis by the author. Descriptive field notes, analytical memos, coding and constant comparisons of interview responses illuminated the theoretical sampling and conceptual rendering of the data. Findings: The analysis of participants' data indicated that the contention between technology and nurses and the inherent complexity of the care process were sources of concern and apprehension within LTC homes. In this study, the participants identified the contention between technology and nurses as the basic social problem or concern and solving the problem involved Improving Care Process through Relational Caring. The participants employed the following strategies to improve the care process: relationship-centredness, intentionality, and managing change. If carried out effectively, these strategies may significantly improve the care process in LTC homes. Conclusion: Care processes in LTC homes involve a series of interrelated and interdependent events. These events included assessing residents' social and health needs, planning care interventions based on mutual agreement, implementing the interventions, and reimagining quality care through multiple lenses. In this study findings revealed the use of InterRAI assessment tool delivered through relational caring can improve care processes. In order to advance the use of InterRAI LTCF tool and software that supports its use, an inclusive change management approach must be used to address context-specific barriers while enhancing facilitators of this important technology at the point of care.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.002 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 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 teacher head, 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".