“The conditions of work are the conditions of care”: a focused ethnography of teamwork in a senior care facility in New Brunswick

Abstract

Researchers have drawn attention to the vulnerable state of senior care facilities across Canada, and the complexity and quality of this work environment. Much work has also been conducted on the development of evidence-based best practice guidelines in elder care. However, research on the implementation of evidence-based work environment best practice guidelines in long-term care, especially for dementia care, is in its infancy. This study explores the process used to implement a Registered Nurses’ Association of Ontario (RNAO) Healthy Work Environment (HWE) Best Practice Guideline (BPG) on teamwork in long-term care and the impact on staff, the work environment, residents, and family members. The following questions guided the study: What process was used to implement the RNAO HWE BPG on teamwork? How did the RNAO HWE BPG influence staff teamwork? What was the impact of the implementation of guideline recommendations on the work environment? How did the implementation of guideline recommendations impact staff, residents, and family members? What social and other contextual factors influenced the implementation process? The study on enhancing teamwork took place in a dementia care unit in a senior care facility in the province of New Brunswick. The methodology was focused ethnography, and methods included in-depth interviews with 12 participants, observation, document review, and research journaling. The main research findings were: Leadership team members (senior managers) initially followed a hierarchical approach to implementation of the RNAO HWE BPG recommendations, which became more collaborative as the process evolved; leadership team members and unit managers (front-line managers) utilized a contextual approach to implementation of BPG recommendations, customizing the process to fit the specific needs of the senior care facility; multiple ways of knowing contributed to the enhancement of teamwork processes; leadership team members and staff both expected the leadership team to play a major role in sustaining teamwork. The RNAO HWE BPG implementation also impacted team members in positive ways: staff reported satisfaction in working together for the benefit of residents and also reported that residents could sense the atmosphere on the unit and react to it. The conclusions indicate that embracing a RNAO HWE BPG teamwork approach can maximize the efforts of staff in a senior care facility and positively impact resident care. Recommendations include: enhancing policies and procedures related to teamwork; fostering self-confidence and agency among team members; supporting flexible leadership for leadership team members and unit managers; developing an education program on multiple ways of knowing; as well as ongoing research and innovation. Implementation science strategies such as facilitation could be used to revisit the evidence-based RNAO HWE BPG and implement subsequent recommendations of the tool.