By Natasha Bryant
A recent evaluation by the LTSS Center found that staff and residents of a New York nursing home benefitted from a contemplative approach to care.
A contemplative care model developed over a decade by the New York Zen Center for Contemplative Care yielded important benefits for staff and residents when it was implemented at a New York nursing home, according to an evaluation by the LeadingAge LTSS Center @UMass Boston.
The contemplative approach to care provides an additional layer of emotional and spiritual support to help staff develop skills to better support residents. The approach, presented to nursing staff through Contemplative Based Resilience Training (CBRT), was implemented for one year from September 2018 to August 2019.
The LTSS Center assessed the contemplative care model’s impact on nursing home residents and nursing home staff who received the intervention, compared to those who did not receive the intervention. Both the intervention and control groups lived on 2, separate long-stay resident floors.
The evaluation team surveyed staff members before and after the intervention, held focus groups with select staff members who participated in the CBRT sessions, and analyzed Minimum Data Set (MDS) assessment data for residents, before and after the intervention.
The Zen Center’s Contemplative Care Team engaged with residents on the intervention floors for about 70 hours a week and held CBRT group sessions with staff. CBRT sessions were held 4 times a week to accommodate staff scheduling.
STAFF SURVEY FINDINGS
Staff who participated in the pre- and post-intervention surveys included certified nursing assistants, nurses, dietitians, therapeutic recreational therapists, social workers, and environmental services professionals. A small sample size made it difficult to detect statistically significant differences in survey results of a small or modest magnitude, if they existed. Positive trends were identified for members of the intervention group who completed the surveys, although those trends did not reach the level of statistical significance. Benefits to staff included:
- Positive perceptions of the supervisor.
- Feeling part of the team.
- Enhanced relationship with co-workers.
- New capacity to resolve issues among co-workers.
- A greater sense of meaning for the work staff was doing, a stronger sense of community, and the perception that staff can make a difference.
- Higher level of resilience.
The majority of staff who participated in CBRT reported that they were very satisfied with the training and that they used the practices they had learned—such as pausing, identifying values and emotions, reflection and response, generous listening, intentional speech, and contemplative practice—to manage routine stress and communicate more effectively.
FOCUS GROUP FINDINGS
Staff members who participated in CBRT reported during focus groups that the program benefitted them professionally and personally. In particular, CBRT taught staff strategies and practices to help them:
- Manage stress.
- Increase resilience.
- Improve their communication with, and approach to caring for, residents.
- Enhance relationships with colleagues.
- Strengthen their sense of community.
- Improve their ability to solve work-related problems.
Staff members reported getting to know residents better because they were able to be more attentive listeners, see residents’ perspective, and understand residents’ needs.
The Contemplative Care Team received positive reviews from staff members who viewed the team as an asset as staff worked to enrich the quality of life for residents by spending more time engaging with them in conversation and meaningful activities.
Nursing home staff were able to witness and learn a non-custodial, relationship-focused approach to care that often influenced resident behavior and staff perception of that behavior. The Contemplative Care Team modeled communication with more “complex” residents. As a result, staff sensed that there were fewer behavioral issues in the intervention group.
The Contemplative Care Team offered ongoing support to members of the nursing home staff during the regular workday. Team members supported staff when they were stressed or upset, discussed insights about residents, and reduced stress by reminding staff members to tap into resources identified during facilitated sessions. Staff members reported finding the work particularly helpful when they were feeling overwhelmed as they worked on floors they perceived as understaffed. The Contemplative Care Team also helped staff feel supported by others, name their emotions, validate their feelings, and remain engaged and present.
IMPACT ON RESIDENT QUALITY MEASURES
Researchers used MDS data for all residents of the intervention and control floors to assess whether the contemplative care intervention improved resident quality of care. The MDS analysis suggested several positive changes in 4 quality indicators for residents of the intervention floors:
- Greater odds of pain-management improvement.
- Lower odds of worsening behavior.
- Greater odds of having lower pain levels affecting a resident’s ability to function.
- Greater odds of having a lower pain-intensity score.
The program had no impact on resident mood.
LESSONS LEARNED
Implementing a pragmatic intervention in a nursing home requires a well-planned and skillfully delivered training program. The skills and practices presented through the intervention must align with the day-to-day tasks and pressures of the normal workday. While results of this intervention were positive, staff from the Zen Center believe periodic “refresher” sessions would be an optimal strategy for sustaining lasting change.
Additionally, researchers found that it is essential to have sustained buy-in throughout the project from middle- and upper-level managers for both the intervention and the research evaluation. A practice improvement is more likely to succeed when it is understood and supported proactively throughout all levels of the organization. This requires training staff, managers, and leadership team members.
In order for the program to succeed, staff members need to:
- Understand and feel some commitment to the desired outcomes.
- Clearly understand the role they will play in achieving the outcomes.
Management should:
- Set an expectation that staff participate in the trainings.
- Help staff members make time for the training while also completing their caregiving responsibilities.
Natasha Bryant is managing director of the Washington, DC, office of the LeadingAge LTSS Center @UMass Boston. Her work focuses on developing, testing, and disseminating workforce improvement initiatives to attract and retain quality staff at all levels of aging services organizations.