Introduction

As an applied researcher and policy analyst who has spent much of my 45-year career trying to understand how to improve the delivery of care in nursing homes (NHs) and other long-term services and supports (LTSS) settings, I applaud Siegel et al. (2023) for this State of the Science Commentary, which challenges the status quo of nursing practice in NHs. For many years, I have argued that the unrelenting emphasis on financing and regulating NHs (and other LTSS settings) is bound to fail without a significant recognition of the role that nursing practice plays in determining resident and staff outcomes.

As Siegel et al. (2023) argue, all models of nursing practice—even those using a team approach—have fallen short of their goals because they have not built their efforts around a relationship-centered team-based framework. NHs are great places for nurses to work for a number of reasons. First, unlike the acute care sector, nurses play a major role in leadership, management, and clinical care. Second, NH organizational structure is relatively flat, providing nurses with the opportunity to cultivate and sustain productive relationships with other members of the clinical team, frontline managers, and certified nursing assistants, who provide the lion's share of hands-on services and supports. Third, nurses in this setting are also able to develop authentic relationships with residents in short-term, post-acute care, but even more so in the long-stay NH where most people will live until death. Nurses have the time to build, nurture, and sustain a relationship-centered team.

Siegel et al. (2023) note that the relationship-centered team model is not a top-down approach; all staff have important roles as part of a team that supports relationships across staff and shifts and with residents and their families. They highlight four key elements that are essential to success: communication, empowerment, coaching/mentoring, and family/care partner involvement (Siegel et al., 2023). These elements seem intuitive and, in theory, should be easy to apply to real world settings. So, why, after so many years of horror stories, studies, commissions, hearings, and investigations, have we not recognized the importance of high-quality nursing practice described in this Commentary?

I strongly support the applied, pragmatic, implementation science approach to research clearly articulated by Siegel et al. (2023). We need to move quickly on their recommendations, including figuring out what it will take to replicate and sustain this model consistently across NH providers. As we face the significant growth of Baby Boomers aged ≥85 years over the next decade, we have no time left to wait. This approach will take a village of stakeholders—NH providers, educators, regulators, payers, consumer and worker advocates, as well as staff, residents, and family/care partners themselves. This is a never-ending journey, but one that will bear fruit if we can make it a reality.

• Siegel E. O., Kolanowski A. M., & Bowers B. J. (2023). A fresh look at the nursing home workforce crisis: Transforming nursing care delivery models. Research in Gerontological Nursing, 16(1), 5–13. 10.3928/19404921/20230104-01
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中文翻译：

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对评论的回应：重新审视疗养院劳动力危机：转变护理服务模式：以关系为中心的团队护理模式：疗养院转型的隐藏解决方案

介绍

作为一名应用研究人员和政策分析师，我在 45 年的职业生涯中大部分时间都在努力了解如何改善疗养院 (NH) 和其他长期服务与支持 (LTSS) 环境中的护理服务，我赞扬 Siegel 等阿尔。(2023) 的科学评论现状，它挑战了 NHs 护理实践的现状。多年来，我一直认为，如果不充分认识到护理实践在决定居民和员工成果方面的作用，那么对 NH（和其他 LTSS 设置）的融资和监管的不懈强调注定会失败。

正如西格尔等人。(2023) 认为，所有的护理实践模型——即使是那些使用团队方法的模型——都没有达到他们的目标，因为他们没有围绕以关系为中心的基于团队的框架来努力。出于多种原因，NH 是护士工作的好地方。首先，与急症护理部门不同，护士在领导、管理和临床护理方面发挥着重要作用。其次，NH 组织结构相对扁平，为护士提供了培养和维持与临床团队其他成员、一线经理和认证护士助理的生产关系的机会，他们提供大部分的实际服务和支持。第三，这种情况下的护士也能够在短期、急性期后护理中与居民建立真正的关系，但在长期住宿的 NH 中更是如此，大多数人将在那里活到死。护士有时间建立、培养和维持以关系为中心的团队。

西格尔等人。(2023) 请注意，以关系为中心的团队模型不是自上而下的方法；作为团队的一部分，所有员工都扮演着重要角色，该团队支持员工和轮班之间以及与居民及其家人的关系。他们强调了对成功至关重要的四个关键要素：沟通、授权、指导/指导和家庭/护理伙伴的参与（Siegel 等人，2023）。这些元素看起来很直观，理论上应该很容易应用于现实世界的设置。那么，为什么经过这么多年的恐怖故事、研究、委托、听证会和调查，我们还没有认识到本评论中描述的高质量护理实践的重要性？

我强烈支持 Siegel 等人明确阐述的应用、实用、实施科学方法进行研究。(2023)。我们需要根据他们的建议迅速采取行动，包括弄清楚如何在 NH 供应商之间一致地复制和维持这种模式。由于我们面临未来十年 85 岁以上婴儿潮一代的显着增长，我们没有时间等待。这种方法将涉及利益相关者——NH 提供者、教育者、监管者、支付者、消费者和工人倡导者，以及员工、居民和家庭/护理伙伴本身。这是一个永无止境的旅程，但如果我们能够实现它，就会结出硕果。

• Siegel EO、Kolanowski AM 和 Bowers BJ（2023 年）。重新审视疗养院劳动力危机：转变护理服务模式。老年护理研究，16 (1), 5–13。10.3928/19404921/20230104-01
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