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Open Access Research article

Identifying resident care areas for a quality improvement intervention in long-term care: a collaborative approach

Lisa A Cranley1*, Peter G Norton2, Greta G Cummings1, Debbie Barnard3, Neha Batra-Garga4 and Carole A Estabrooks1

Author Affiliations

1 Faculty of Nursing, University of Alberta, Level 3 Edmonton Clinic Health Academy, 11405 87 Avenue, Alberta, Edmonton, T6G 1C9, Canada

2 Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada, Mailing address: 56 George Street, Creemore, Ontario, L0M 1G0, Canada

3 Quality and Patient Safety, Health Sciences North, 41 Ramsey Lake Road, Sudbury, Ontario, P3E 5J1, Canada

4 Strategy and Knowledge, Community Treatment and Support, Addiction and Mental Health, Alberta Health Services, #210, 10909 Jasper Avenue, Associated Engineering Plaza, Edmonton, Alberta, T5J 3M9, Canada

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BMC Geriatrics 2012, 12:59  doi:10.1186/1471-2318-12-59

Published: 25 September 2012



In Canada, healthcare aides (also referred to as nurse aides, personal support workers, nursing assistants) are unregulated personnel who provide 70-80% of direct care to residents living in nursing homes. Although they are an integral part of the care team their contributions to the resident care planning process are not always acknowledged in the organization. The purpose of the Safer Care for Older Persons [in residential] Environments (SCOPE) project was to evaluate the feasibility of engaging front line staff (primarily healthcare aides) to use quality improvement methods to integrate best practices into resident care. This paper describes the process used by teams participating in the SCOPE project to select clinical improvement areas.


The study employed a collaborative approach to identify clinical areas and through consensus, teams selected one of three areas. To select the clinical areas we recruited two nursing homes not involved in the SCOPE project and sampled healthcare providers and decision-makers within them. A vote counting method was used to determine the top five ranked clinical areas for improvement.


Responses received from stakeholder groups included gerontology experts, decision-makers, registered nurses, managers, and healthcare aides. The top ranked areas from highest to lowest were pain/discomfort management, behaviour management, depression, skin integrity, and assistance with eating.


Involving staff in selecting areas that they perceive as needing improvement may facilitate staff engagement in the quality improvement process.

Quality improvement; Healthcare providers; Quality care; Long-term care