JAMDA
Volume 7, Issue 5 , Pages 271-278, June 2006

A Clinical Pathway for Treating Pneumonia in the Nursing Home: Part I: The Nursing Perspective

  • Soo Chan Carusone, MSc

      Affiliations

    • Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
    • ,
  • Mark Loeb, MD, MSc

      Affiliations

    • Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
    • Department of Pathology and Molecular Medicine, McMaster University
    • ,
  • Lynne Lohfeld, PhD

      Affiliations

    • Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
    • Program for Educational Research and Development, McMaster University
    • Corresponding Author InformationAddress correspondence to Lynne Lohfeld, PhD, McMaster University, Michael DeGroote Centre for Learning, Room 3521, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada.

published online 01 February 2006.

Objectives

This paper examines nursing staff’s perspectives on the utility and sustainability of a clinical pathway for treating nursing home residents with pneumonia.

Design

A qualitative (case study) design was used.

Setting

Data were collected from 6 nursing homes in Southern Ontario (5 from metro regions and 1 from a nonmetro region). Nursing homes were drawn from a larger randomized controlled trial of a clinical pathway for nursing home–acquired pneumonia conducted between 2001 and 2005. The clinical pathway was designed to assist in the identification, diagnosis, and management of pneumonia, including a decision tool for determining the appropriate location of treatment (hospital versus nursing home).

Participants

A total of 7 focus groups and 1 one-on-one interview were conducted between February 2003 and May 2004. Interview data were analyzed using the template style, described by Miller and Crabtree, to identify key themes.

Findings

Nurses strongly supported the idea of the clinical pathway and believed that providing pneumonia care in the nursing home was better for the resident. As a result of using the clinical pathway, nurses felt that pneumonia was being identified, diagnosed, and treated earlier, resulting in fewer hospitalizations. In addition to the benefits to resident care, the nurses felt that their skills and knowledge also improved. Nurses generally supported the implementation of the pathway although some concern was expressed about the additional responsibility and resources that would entail.

Conclusions

The implementation of a clinical pathway for treating pneumonia in nursing homes and quick access to a backup clinician are desired by nurses who also believe it will result in better care and fewer hospitalizations of residents.

Keywords:  Qualitative research , nursing home , nursing , pneumonia care , clinical pathway

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 This research study was funded as part of a Canadian Institutes of Health Research (CIHR) Interdisciplinary Health Research Team (IHRT) grant. S.C.C. is the recipient of a CIHR Canada Graduate Scholarship Doctoral Award.

PII: S1525-8610(05)00642-0

doi:10.1016/j.jamda.2005.11.004

JAMDA
Volume 7, Issue 5 , Pages 271-278, June 2006

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