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Randomized Controlled Trial
. 2014 Feb;23(1):36-53.
doi: 10.1177/1054773812470840. Epub 2013 Jan 3.

Provider staffing effect on a decision aid intervention

Mary Ersek  1 , Justine S Sefcik, Feng-Chang Lin, Tae Joon Lee, Robin Gilliam, Laura C Hanson
Affiliations
Randomized Controlled Trial

Provider staffing effect on a decision aid intervention

Mary Ersek et al. Clin Nurs Res. 2014 Feb.

Abstract

This study examined the association between Nurse Practitioner (NP) and Physician Assistant (PA) staffing in nursing homes and the effect of a decision aid regarding feeding options in dementia on the frequency of surrogate-provider discussions and on surrogates' decisional conflict. We compared these outcomes for facilities that had no NPs/PAs, part-time-only NP/PA staffing, and full-time NP/PA staffing. The sample included 256 surrogate decision makers from 24 nursing homes. The decision aid was associated with significant increases in discussion rates in facilities with part-time or no NP/PA staffing (26% vs. 51%, p < .001, and 13% vs. 41%, p < .001, respectively) and decreases in decisional conflict scores (-0.08 vs. -0.047, p = .008, and -0.30 vs. -0.68, p = .014, respectively). Sites with full-time NP/PA staffing had high baseline rates of discussions (41%). These findings suggest that the decision aid and full-time NP/PA staffing can enhance surrogate decision making in nursing homes.

Keywords: advance practice nursing; decision making; dementia; nursing home; nutrition.

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Figures

FIGURE 1
FIGURE 1. Analytic Schema
The major aim of the parent study was to examine the efficacy of the Decision Aid on Decisional Conflict and number of discussions about feeding options when compared with Usual Care. Analyses showed that the Decision Aid was associated with reduced Decisional Conflict and greater number of surrogate-reported discussions compared to Usual Care (Hanson et al, 2011). The present analysis sought to examine the association of NP/PA staffing patterns with the Decision Aid on outcomes.
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References

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