Development and content validation for a self-assessment instrument of care quality in long-term care facilities for older adults

Vieira, Bruno Luís de Carvalho; Martins, Arianne Correa; Ferreira, Raquel Conceição; Vargas, Andréa Maria Duarte

doi:10.1590/1981-22562024027.230173.en

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Original Articles • Rev. bras. geriatr. gerontol. 27 • 2024 • https://doi.org/10.1590/1981-22562024027.230173.en copy

Development and content validation for a self-assessment instrument of care quality in long-term care facilities for older adults

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To develop and validate the content of a self-assessment instrument for the quality of care in Long-Term Care Facilities for Older Adults (Instituições de Longa Permanência para Idosos - ILPIs), named QualificaILPI.

Method

A methodological study conducted between March and December 2021. The instrument was developed based on a multidimensional quality model, Brazilian legislation, and literature research. It contains quality standards for self-assessment of ILPIs in the dimensions of environment, home, care, family and community involvement, work team, and management. Each standard is described and followed by a scale with parameters to classify the level of ILPI quality as incipient, intermediate, or consolidated. The modified Delphi Technique was employed for validation by a committee of 10 experts regarding the relevance of the standard for ILPI quality assessment, the appropriateness of objectives, the evaluation scale, and clarity, allowing for comments. The standard was retained when there was 75% agreement among the experts. The instrument was also evaluated by the target audience, consisting of coordinators from 10 ILPIs selected for convenience.

Results

In the first assessment cycle, three standards were excluded, and two new ones were created. In the second cycle, the dimension of one standard was changed, and two standards were combined. In the end, 29 standards remained, divided into six dimensions. The target audience, ILPI managers, suggested changes in the wording of some standards. There was a consensus of 80% or higher for all standards.

Conclusion

QualificaILPI has the potential to contribute to monitoring ILPIs, promoting the improvement of care offered to residents.

Keywords
Delphi Technique; Long-Term Care; Aged; Self-Assessment; Quality of Healthcare

Dimensions	Concepts
Environment	The concept of environmental docility was employed, referring to friendly spaces resulting from the provision of compensatory physical and psychosocial resources to promote the physical health, functionality, safety, residence identity, and psychological well-being of the resident. As the individual's abilities decline, and behavior becomes dependent on external factors, it becomes necessary to enhance the resident's environment to enable a more dignified, secure, and well-being-centered living experience⁷7 Iijima K, Arai H, Akishita M, Endo T, Ogasawara K, Kashihara N, et al. Toward the development of a vibrant, super-aged society: The future of medicine and society in Japan. Geriatr Gerontol Int. 2021 Aug;21(8):601–13. Disponível em: https://doi.org/10.1111/ggi.14201 https://doi.org/10.1111/ggi.14201... ,¹⁴14 Jones J, Hunter D. Qualitative Research: Consensus methods for medical and health services research. BMJ. 1995 Aug 5;311(7001):376–80. Disponível em: https:// doi: 10.1136/bmj.311.7001.376.,.
Work Team	It pertains to the team of professionals involved in providing care to older adults residing in ILPIs. It is essential to consider the technical requirements for each professional category, ensure the minimum number of professionals, establish ongoing education, and enhance the work process to ensure professional satisfaction and, consequently, better meet the needs of the residents¹⁰10 Vieira BL de C, Martins AC, Ferreira RC, Vargas AMD. Quality of care in long-term care institutions: A scoping review of literature. Res Soc Dev. 2021 Jul 10;10(8):e17110817117. Disponível em: https://doi: https://doi.org/10.33448/rsd-v10i8.17117. https://doi.org/10.33448/rsd-v10i8.17117... ,¹⁴14 Jones J, Hunter D. Qualitative Research: Consensus methods for medical and health services research. BMJ. 1995 Aug 5;311(7001):376–80. Disponível em: https:// doi: 10.1136/bmj.311.7001.376.,¹⁵15 Buedo-Guirado, C, Rubio, L, Dumitrache, CG, and Romero-Coronado, J. Active aging program in nursing homes: Effects on psychological well-being and life satisfaction. Interv Psicosoc. 2020; 29(1):49-57, 2020. Disponível em: https://doi: 10.5093/pi2019a18.,.
Care	Care encompasses any action aimed at meeting the basic needs of older adults, including promoting self-care, self-esteem, and self-appreciation. ILPIs should consistently care for older adults with respect and attentive listening, empathy, and encouragement of autonomy and independence whenever possible. Care is crucial for the quality of life and survival of older adults¹⁴14 Jones J, Hunter D. Qualitative Research: Consensus methods for medical and health services research. BMJ. 1995 Aug 5;311(7001):376–80. Disponível em: https:// doi: 10.1136/bmj.311.7001.376.,¹⁵15 Buedo-Guirado, C, Rubio, L, Dumitrache, CG, and Romero-Coronado, J. Active aging program in nursing homes: Effects on psychological well-being and life satisfaction. Interv Psicosoc. 2020; 29(1):49-57, 2020. Disponível em: https://doi: 10.5093/pi2019a18.,.
Home	Older adults residing in ILPIs should feel as if they are in their own homes. With a welcoming environment, ILPIs should preserve habits, autonomy, safe social interaction, hygiene, health, accessibility, and privacy. When this occurs, the older adults perceives the staff as friends and family, feeling at home, participating in ILPI activities with freedom and privacy¹⁴14 Jones J, Hunter D. Qualitative Research: Consensus methods for medical and health services research. BMJ. 1995 Aug 5;311(7001):376–80. Disponível em: https:// doi: 10.1136/bmj.311.7001.376.,¹⁶16 Gilissen J, Pivodic L, Wendrich-van Dael A, Cools W, Vander Stichele R, Van den Block L, Deliens L, Gastmans C.Nurses’ self-efficacy, rather than their knowledge, is associated with their engagement in advance care planning in nursing homes: A survey study. J Palliat Med. 2020;34(7):917-24. Disponível em: https://doi: 10.1177/0269216320916158.,.
Family and Community Involvement	The ideal scenario is to maintain older adults in their own family environment, but if that is not possible, a collective home is an option. Nonetheless, it is essential to maintain involvement with family and the community, promoting autonomy and quality of life. This interaction helps to preserve mental health, satisfaction, and independence¹⁰10 Vieira BL de C, Martins AC, Ferreira RC, Vargas AMD. Quality of care in long-term care institutions: A scoping review of literature. Res Soc Dev. 2021 Jul 10;10(8):e17110817117. Disponível em: https://doi: https://doi.org/10.33448/rsd-v10i8.17117. https://doi.org/10.33448/rsd-v10i8.17117... ,¹⁷17 Minayo MC, Almeida LC. Importância da política nacional do idoso no enfrentamento da violência. In: Política Nacional do idoso: velhas e novas questões. Ed. Rio de Janeiro: IPEA. 2016: 435-456.,.
ILPI Management	The management of the ILPI encompasses administrative processes aimed at achieving outcomes, ensuring a better quality of life for older adults, based on regulations that must be followed and established by legislation¹⁰10 Vieira BL de C, Martins AC, Ferreira RC, Vargas AMD. Quality of care in long-term care institutions: A scoping review of literature. Res Soc Dev. 2021 Jul 10;10(8):e17110817117. Disponível em: https://doi: https://doi.org/10.33448/rsd-v10i8.17117. https://doi.org/10.33448/rsd-v10i8.17117... ,¹⁸18 Caspari S, Råholm MB, Sæteren B, et al. Tension between freedom and dependence-A challenge for residents who live in nursing homes. J Clin Nurs. 2018;27(21-22):4119-4127. Disponível em: https://doi: 10.1111/jocn.14561,.

	Aspects evaluated by experts in the two validation cycles
Dimensions	Relevance of the standard for assessing the quality of long-term care		Relevance of the standard for dimension assessment		Proper understanding			Proper description of the purpose of the pattern		Proper scale
Environment	Cicle 1	Cicle 2	Cicle 1	Cicle 2		Cicle 1	Cicle 2	Cicle 1	Cicle 2	Cicle 1	Cicle 2
Standards
1	90.9	100	90.9	100		90.9	100	81.2	100	81.2	100
2	100	100	90	100		81,8	100	72.7*	100	63.6*	100
3†	100	90	100	90		100	100	100	100	100	100
4	100	100	100	100		100	100	100	100	100	100
5‡	72.8*		72.8*			72.8*		81.8		72.8*
6	90.9	100	81.8	100		90.9	100	90.9	100	90.9	100
Work Team Standards
1‡	90.9		90.9			100		100
1	90.9	100	90.9	100		90.9	100	100	100	100	100
2	90.9	100	100	100		100	100	100	100	100	100
3	100	100	100	100		90.9	100	100	90	90.9	100
4	100	100	100	100		100	100	100	100	100	100
5	100	100	100	100		100	100	100	100	100	100
Care Standards
1	100	100	100	100		100	100	100	100	100	100
2	100	100	100	100		100	100	100	100	100	100
3	90.9	100	90.9	90		90.9	100	90.9	100	100	100
4§	100	100	100	100		100	100	100	100	100	100
5	100	100	100	100		100	100	100	100	100	100
6	100	100	100	100		100	100	100	100	100	100
7	90.1	100	90.1	90		100	100	100	100	100	100
8	100	100	90.1	100		100	100	100	100	100	100
9º §	90.1		81.8			90.1				100
10 \|\|	100		90.1			100		100		100
9	81.8	100	81.8	90		199	100	100	100	100	90
11‡	81.8		81.8			100		100		100
12‡	90.1		90.1			100		100		100
13‡	81.8		81.8			100		100		100
9		100		100			100		100		100
10		100		90			100		100		90
Home Standards
1	90.9	90	90.9	90		90.9	90	90.9	100	81.8	100
2 **	100	90	100	90		100	100	100	100	100	100
3 \|\|	90.9	90	90.9	90		100	100	100	100	100	100
4	81.8		81.8			100		100		100
3†		90		90			100		100		100
Family and Community Involvement Standards
1 **	81.8	100	81.8	100		100	100	100	100	100	100
2	90.9	100	90.9	100		100	100	100	100	100	100
ILPI Management Standards
1	100	100	100	100		100	100	100	100	100	100
2	100	100	100	100		100	100	100	100	100	100
3	81.8	90	81.8	90		100	100	100	100	100	100
4	100	100	100	100		100	100	100	100	100	100


Standards	Clarity of standards (%) Yes	Usefulness of self-assessment for ILPIs (% always and sometimes)		Adequacy of the instrument to differentiate the levels of quality of care in the ILPI (% yes)
Dimension 1: Environment
		Always	Sometimes
1	100	100		90
2	100	100		80
3	90	100		100
4	100	80	20	100
5	100	80	20	90
Dimension 2: Work Team
1	100	100		100
2	100	90	10	100
3	100	90	10	80
4	100	90	10	100
5	100	90	10	90
Dimension 3: Care
1	100	90	10	90
2	100	90	10	100
3	100	80	20	90
4	100	90	10	100
5	100	80	20	90
6	100	90	10	100
7	100	80	20	100
8	90	90	10	90
9	100	90	10	100
10	100	80	20	100
Dimension 4: Home
1	100	90	10	100
2	100	80	20	90
3	100	70	30	90
Dimension 5: Community Family Involvement
1	100	80	20	100
2	100	80	20	90
Dimension 6: Management
1	100	70	30	80
2	100	70	30	80
3	90	70	30	80
4	100	80	20	100

Standards	Dimension 1: Environment
1	Mobility and safety issues
2	Adequacy of bedrooms
3	Common area, green area, internet access
4	Appropriate location for medications
5	Cleanliness and hygiene (presence of odors)
Dimension 2: Work Team
1	Adequate number of caregivers considering the resident's level of dependency
2	Technical supervisor
3	Caregivers with training courses
4	Continuous education
5	Team meetings
Dimensão 3: Care
1	Proper nutrition
2	Technical standards and routines for food processing
3	Medical care plan
4	Individualized resident registry
5	Prevention of violence
6	Physical activities
7	Recreational and cultural activities
8	Occupational activities
9	Daily dental care, including denture cleaning
10	Healthcare
Dimension 4: Home
1	Intergenerational activities
2	Consideration of resident preferences
3	Participation in household decisions
Dimension 5: Family and Community Involvement
1	Encouraging family and community participation
2	Integration with educational institutions
Dimension 6: Management
1	Use of indicators to monitor performance
2	Discussion of monitoring with collaborators
3	Public health participation in planning
4	Strategies to avoid professional turnover

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[1] Correspondence Raquel Conceição Ferreira raquelcf@ufmg.br

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Development and content validation for a self-assessment instrument of care quality in long-term care facilities for older adults

Abstract

﻿Objective

Method

Results

Conclusion

Objective