Translating the Nursing Care Plan into Practice: Applying Usability and User-Centered Design Principles to Develop a Care Plan Reference Tool and Communication Process for Direct Care Staff to Provide Individualized, Quality Care to Nursing Home Residents

Abstract

The nursing home resident care plan is intended to drive individualized, person-centered care for residents and serve as a communication tool for the care team. The care planning process has evolved to meet other external needs, such as regulatory and payment requirements, with the care plan becoming increasingly lengthy and complex. This complexity creates challenges in translating the care plan into concise and useful information for nursing assistants to reference at the point of care. Following a three-phase, multiple case study design, user-centered design principles were applied to develop and test a care plan reference tool and communication process to provide nursing assistants the information they deemed necessary to provide individualized, quality care. In the first study phase, thirteen key requirements were identified that were perceived by nursing assistants as impacting care plan quality of use. These requirements were translated into user requirements to guide the design of a care plan reference tool and communication process in the second study phase. Prototypes were designed and tested using an iterative participatory design process that included nursing assistants from the two nursing home study sites. The final design was tested during the third study phase. To test the new design compared to the pre-study design, eleven nursing assistants from the two study sites who had not participated in the first two study phases were recruited and randomly assigned to the treatment or control group. Participants applied the care plan reference tool and process to four common use cases and completed a Quality of Use survey. The survey findings indicated that the resident care plan reference tool and process designed following user-centered design principles resulted in significantly higher levels of staff perceived quality of use than the baseline resources available to staff. The study findings demonstrate the need for a succinct and useful care plan reference tool combined with a dynamic two-way communication process between all team members. Study findings also reinforced the critical importance of engaging those closest to the work early and often in the design and implementation of key practices, processes, and resources which is a hallmark of user-centered design.