Introduction

As I turn the page to 2023, I have renewed hope for the future and a greater sense of urgency about making my efforts count to improve the world for older adults and their families. Although still shaken from the past 3 years of disruption, tragedy, and reckoning, I appreciate the importance of concerted effort around solving important problems together. One of the gifts of disruption is the recognition that we do not have to cling to assumptions as strongly—there are opportunities to rethink how we approach our efforts and try new ways of thinking. These lessons are germane to our State of the Science Commentary, so thoughtfully contributed by Drs. Siegel, Kolanowski, and Bowers (2023). They tackle an age-old, seemingly intractable problem—quality of care and life in nursing homes (NHs).

The pandemic has brought into even greater focus the urgency of transformation in this sector of health care delivery, where 21% of all coronavirus disease 2019 (COVID-19) deaths occurred (Cronin & Evans, 2022). With >26,000 skilled nursing facilities and a NH capacity of 1.1 million beds in the United States, between January 2020 and December 2022, 1,420,388 residents of NHs had confirmed cases of COVID-19, with 161,858 deaths (Centers for Medicare & Medicaid Services [CMS], 2022). During that same period, 1,466,611 staff had confirmed cases, with 2,874 deaths (CMS, 2022). Beyond the statistics of morbidity and mortality, there are the personal stories of isolation, inadequate resources and staffing, exhaustion, fear, and frustration. A crisis, such as the pandemic, lays bare the cracks in a system and its lack of capacity to respond with greater effort and creativity when called upon most urgently.

For these reasons, the Research in Gerontological Nursing Editorial Board prioritized a closer look at how gerontological nursing research can contribute to improvement in NHs. The authors of our State of the Science Commentary acknowledge that there are many issues to be addressed (Siegel et al., 2023). Rather than being paralyzed into inaction, they review the evidence around models of care in NHs and make a bold recommendation for future attention. They posit that we can make improvements if we focus on those aspects of care within the purview of professional nurses, organizing relationship-centered care delivery around important assumptions that optimize the effectiveness of the team and each person's contributions to quality of care and quality of life for residents and staff.

The evidence presented around a relationship-based model strikes a strong chord of recognition and seems so obvious yet has not been a core emphasis in NHs, where residents are coping with health and functional changes and staff are strained to meet their needs. I have spent many years in several roles in NHs, starting as a teenaged nursing assistant, then a RN, geriatric nurse practitioner, nursing home administrator, chief operating officer of a company that designed and managed community-based long-term care, nurse scientist, and as a granddaughter at the bedside of my grandfather in his last days. In all those roles and from all those perspectives, I noticed that relationships matter. They mattered to me as a staff member, being heard, seen, and valued. I could tell they mattered to residents and families who responded so positively when they were asked about their values and preferences and when staff made meaningful connections with them as they delivered care that aligned with their priorities. They mattered to me as a leader as I observed the power of authentic communication and engagement on team effectiveness and morale. They mattered to me as a nurse scientist as I pondered how to implement and sustain quality improvement. And they mattered to me as I grieved the loss of my grandfather, and the nurses and nursing assistants provided the support our family needed. Relationships enable effective teamwork and strong communication, and they provide a basis for finding meaning and purpose in our shared environment.

Although intuitively obvious, enacting such a model will require concerted effort. Siegel et al. (2023) provide a roadmap for us as gerontological nurse scientists. They start with measurement and the importance of coming to consensus in our research community around definitions and standardized measurement. I hope that this suggestion to standardize definitions and measurement sparks creative thought and discussions in our research groups and among our colleagues. They identify methodological considerations for evaluating organizational readiness and model effectiveness, important for thoughtful study design. They raise important questions about the culture of NHs and structural racism. And they call for greater awareness among funders and in nursing education to advance the system change that is so urgently needed.

The National Academies of Sciences, Engineering, and Medicine (2022) report, “The National Imperative to Improve Nursing Home Quality: Honoring our Commitment to Residents, Families and Staff,” makes two major recommendations for priority research. The first is to identify care delivery models that reduce care disparities and strengthen connections among NHs, their communities, and the broader health care and social service sectors. The second recommendation is to evaluate innovations in all aspects of care, including optimal staffing, physical environment, financing and payment, use of technology, leadership models, and organizational policy. These recommendations are squarely in the expertise of gerontological nurse researchers. We have the potential to change lives by shining the light on best nursing practices that optimize quality of care and life for older adults and their families. Consider how a relationship-centered ecological approach could enhance your scientific explorations and reach out to your colleagues to build the momentum we need for real change.

Heather M. Young, PhD, RN, FAAN, FGSA

Editor

• Centers for Medicare & Medicaid Services. (2022). COVID-19 nursing home data. https://data.cms.gov/covid-19/covid-19-nursing-home-data
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• Cronin C. J., & Evans W. N. (2022). Nursing home quality, COVID-19 deaths, and excess mortality. Journal of Health Economics, 82, 103592. 10.1016/j.jhealeco.2022.102592
  CrossrefGoogle Scholar
• National Academies of Sciences, Engineering, and Medicine. (2022). The national imperative to improve nursing home quality: Honoring our commitment to residents, families and staff. https://www.nationalacademies.org/our-work/the-quality-of-care-in-nursing-homes
  Google Scholar
• Siegel E. O., Kolanowski A. M., & Bowers B. J. (2023). A fresh look at the nursing home workforce crisis: Transforming nursing care delivery methods. Research in Gerontological Nursing, 16(1), 5–13. 10.3928/19404921-20230104-01
  LinkGoogle Scholar

中文翻译：

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以关系为中心的护理：改善疗养院结果的途径

介绍

当我翻到 2023 年时，我对未来重新燃起了希望，并且更加紧迫地意识到要努力为老年人及其家人改善世界。尽管仍然对过去 3 年的混乱、悲剧和清算感到震惊，但我明白齐心协力共同解决重要问题的重要性。颠覆的礼物之一是认识到我们不必如此强烈地坚持假设——有机会重新思考我们如何处理我们的努力并尝试新的思维方式。这些课程与我们的科学评论状况密切相关，由 Drs 精心贡献。西格尔、科拉诺夫斯基和鲍尔斯 (2023)。他们解决了一个古老的、看似棘手的问题——疗养院 (NHs) 的护理质量和生活。

大流行使人们更加关注这一医疗保健服务部门转型的紧迫性，2019 年所有冠状病毒病 (COVID-19) 死亡病例中有 21% 发生在该部门（Cronin & Evans，2022）。2020 年 1 月至 2022 年 12 月期间，美国拥有超过 26,000 个专业护理设施和 110 万张床位的 NH，1,420,388 名 NHs 居民确诊了 COVID-19 病例，其中 161,858 人死亡（医疗保险和医疗补助服务中心 [CMS ], 2022). 同一时期，有 1,466,611 名员工确诊病例，其中 2,874 人死亡（CMS，2022）。除了发病率和死亡率的统计数据之外，还有孤立、资源和人员配备不足、疲惫、恐惧和沮丧的个人故事。危机，例如大流行，

出于这些原因，老年护理研究编辑委员会优先仔细研究老年护理研究如何促进 NHs 的改善。我们的科学评论现状的作者承认有许多问题需要解决（Siegel 等人，2023 年）。他们没有陷入无所作为，而是审查了有关 NHs 护理模式的证据，并为未来的关注提出了大胆的建议。他们认为，如果我们专注于专业护士职权范围内的护理方面，围绕优化团队效率和每个人对护理质量和生活质量的贡献的重要假设组织以关系为中心的护理服务，我们就可以做出改进为居民和工作人员。

围绕基于关系的模型提出的证据引起了强烈的认可，而且看起来如此明显，但并不是 NH 的核心重点，那里的居民正在应对健康和功能变化，而工作人员则竭力满足他们的需求。多年来，我在 NH 担任过多个职位，从一名青少年护理助理开始，然后是注册护士、老年执业护士、疗养院管理员、一家设计和管理社区长期护理的公司的首席运营官、护士科学家，以及在祖父最后的日子里作为孙女守在祖父床边。在所有这些角色中，从所有这些角度来看，我注意到关系很重要。作为一名工作人员，他们对我很重要，被听到、被看到和被重视。我可以看出他们对居民和家庭很重要，当他们被问及他们的价值观和偏好时，以及当工作人员在他们提供符合他们优先事项的护理时与他们建立有意义的联系时，他们的反应如此积极。当我观察到真实的沟通和参与对团队效率和士气的影响时，他们对我来说很重要。作为一名护士科学家，当我思考如何实施和维持质量改进时，它们对我很重要。当我为失去祖父而悲痛时，他们对我很重要，护士和护理助理提供了我们家庭所需的支持。关系可以实现有效的团队合作和强有力的沟通，它们为在我们共享的环境中寻找意义和目的提供了基础。

虽然直观上显而易见，但实施这样的模型需要齐心协力。西格尔等人。(2023) 为我们作为老年学护士科学家提供了路线图。他们从测量开始，以及在我们的研究界围绕定义和标准化测量达成共识的重要性。我希望这个标准化定义和测量的建议能在我们的研究小组和同事之间激发创造性的思考和讨论。他们确定了评估组织准备情况和模型有效性的方法论考虑因素，这对于深思熟虑的研究设计很重要。他们提出了有关 NH 文化和结构性种族主义的重要问题。他们呼吁提高资助者和护理教育的意识，以推进迫切需要的系统变革。

美国国家科学院、工程院和医学院 (2022) 的报告“提高疗养院质量的国家当务之急：履行我们对居民、家庭和员工的承诺”，提出了两项​​优先研究的主要建议。首先是确定护理提供模式，以减少护理差异并加强 NH、他们的社区以及更广泛的医疗保健和社会服务部门之间的联系。第二项建议是评估护理各个方面的创新，包括最佳人员配置、物理环境、融资和支付、技术使用、领导模式和组织政策。这些建议完全符合老年学护士研究人员的专业知识。我们有可能通过阐明最佳护理实践来改变生活，这些实践可以优化老年人及其家人的护理质量和生活。考虑以关系为中心的生态方法如何加强您的科学探索并与您的同事接触以建立我们实现真正变革所需的动力。

Heather M. Young，博士，注册护士，FAAN，FGSA

编辑

• 医疗保险和医疗补助服务中心。（2022 年）。COVID-19 疗养院数据。https://data.cms.gov/covid-19/covid-19-nursing-home-data
  谷歌学术
• Cronin CJ, & Evans WN ( 2022 ). 疗养院质量、COVID-19 死亡人数和超额死亡率。卫生经济学杂志, 82 , 103592.10.1016/j.jhealeco.2022.102592
  交叉引用谷歌学术
• 美国国家科学院、工程院和医学院。（2022 年）。提高疗养院质量的国家当务之急：履行我们对居民、家庭和员工的承诺。https://www.nationalacademies.org/our-work/the-quality-of-care-in-nursing-homes
  谷歌学术
• Siegel EO、Kolanowski AM 和 Bowers BJ（2023 年）。重新审视疗养院劳动力危机：转变护理服务方式。老年护理研究，16 (1), 5–13。10.3928/19404921-20230104-01
  链接谷歌学术