Examining the Relationship Between Leadership, Facilitation, and Short Term Sustainability of a Dementia Specific Training Program in Rural Long-Term Care Homes
Danylyshen-Laycock, Tracy L 1972-
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In rural long-term care (LTC) homes staff have limited access to dementia specialty services and education to support them in caring for residents with dementia with responsive behaviours. A sustainable, in house, dementia-specific training program is one way to change practice to improve quality of care and keep staff and residents safe. However, the implementation and sustainability of new evidence and programs is complex and influenced by many elements. With a retrospective study (five homes), and a prospective study (two homes) over 15 months this dissertation examined how facilitation and leadership were related to short-term sustainability of a dementia-specific training program (Gentle Persuasive Approaches [GPA]) in rural LTC homes. Based on the data from both studies (focus groups, semi-structured interviews, observations, and shadowing), a key finding of this research was that of variability across the seven homes in the sustainability of the GPA program, with a continuum of low, medium, and high sustainability. Both leadership and facilitation were important for sustainability but leadership was the key factor. The characteristics of the formal leaders determined the culture in the home, which influenced the degree of sustainability of the program. Paper 1 describes these leadership characteristics and their impact on the home’s culture and GPA sustainability. Leaders who created a person-centred culture of care displayed interactive social and relationship-building skills that enabled staff to use the GPA program in their daily practice. Paper 2 examines the relationship between facilitation and sustainability. The GPA program was more likely to be sustained when there was more informal facilitation, GPA Coaches were credible, and there was someone in a formal facilitation role (e.g., clinical nurse leader) who coached and role modelled. Overall, this research found that the stronger the leadership, the more person-centred the culture of care is, which enables facilitators to help staff create change. This research addresses a gap in the area of implementation science related to leadership and facilitation in LTC settings and how these two concepts interact. This research will assist senior leadership in LTC homes to identify barriers to sustainability leading to better outcomes for residents, staff, and families.
DegreeDoctor of Philosophy (Ph.D.)
CommitteeKirychuk, Shelley; Stewart, Norma; O'Connell, Megan; Goodridge, Donna
Copyright DateApril 2019
Leadership, Facilitation, Sustainability, Rural Long-Term Care Homes