Data Analysis

After   all   interviews   were   transcribed,   thematic   analysis   (Vaismoradi   et   al,   2013)   was  used  to  identify  themes  that  arose  from  large  amounts  of  interview  data.  The   findings   can   broadly   be   divided   into   five   major   thematic   categories:   attitudes   to   interRAI-­‐LTCF,   lack   of   time,   engagement   with   technology,   training   needs   and   relevance  of  interRAI-­‐LTCF  in  aged  residential  care.  These  will  be  discussed  next.    

4.2.1   Theme  1:  Attitudes  Towards  interRAI-­‐LTCF   4.2.1.1  Positive  attitudes  

Positive  training  experiences  

Most   RNs   in   this   study   expressed   positive   attitudes   towards   interRAI-­‐LTCF.   The   positive   attitudes   were   developed   in   the   beginning   of   the   interRAI   experience,   during   the   training.   Trainers   appeared   to   have   a   big   influence   on   how   RNs   attitudes  towards  interRAI-­‐LTCF  were  formed.  

“I  felt  really  excited  and  elated  when  I  was  chosen  to  do  the  training,   and   then   I   read   through   the   interRAI   and   what   it   is   and…resident   assessment  instrument…I  was  like  wow,  this  could  be  an  amazing  tool   to  help  and  I  really  liked  that.”  (P8)  

“Positive.  It  was  down  to  the  tutors.  The  personality  of  the  tutors,  they   were  supportive,  they  were  helpful,  they  were  beside  you  in  a  moments   notice.  You  could  ring  them  anytime.“  (P3)  

“Positive,  because  the  trainer  that  I  had  was  quite  good.  She  was  very   helpful.  I  can  ring  her  anytime.  For  me  it  was  positive.”  (P6)  

“It   was   good.   We   had   a   very   helpful   teacher.   We   went   through   the   basic   stuff   and   we   completed   the   first   assessment   together,   which   made   it   easier.   It   was   quite   good,   like   simple   and   easy   for   me.   Plus   because  of  my  computers  skills,  it  was  easy  for  me.  Not  a  hard  thing.   It’s   just   a   matter   of   reading   the   books   and   how   you   code   the   assessments.”  (P7)  

Trainers  were  usually  very  available  and  often  the  first  person  RNs  would  contact   if   they   needed   assistance.   Many   reported   having   a   good   relationship   with   their   trainers,  even  after  their  training.    

“I   know   my   tutor’s   numbers,   they   are   in   my   book.   She’s   always   available.”  (P7)  

Usefulness  of  interRAI-­‐LTCF  

RNs  also  had  positive  attitudes  towards  interRAI-­‐LTCF  assessments  if  it  meant  that   the   resident   would   benefit   from   it.   RNs   believed   that   completing   interRAI-­‐LTCF   assessments  was  their  responsibility,  and  a  part  of  the  care  they  provide.    

“It’s  part  of  my  job.  It’s  part  of  the  care  I  provide  for  my  resident.  In  the   end   of   it   I   know   that   it   will   create   an   outcome,   which   will   help   me   create  a  care  plan,  which  will  help  provide  best  care  for  my  resident.  So   if   there   are   any   changes   in   the   resident,   I’m   always   happy   to   do   an  

interRAI   assessment,   so   that   we   can   all   get   together   and   create   best   possible  care  for  the  resident.  So  I’m  happy  about  it.”  (P10)  

The   most   useful   aspect   of   interRAI-­‐LTCF,   according   to   RNs,   was   when   admitting   new  residents  to  an  ARCF;  RNs  valued  receiving  comprehensive  information  about   the  resident’s  medical  history,  and  their  baseline  nursing  assessment.    

“I’ve   learned   more   about   the   resident   from   interRAI.   You   get   the   background   of   them   prior   to   admission,   and   see   the   change   what’s   happened.  It’s  just  better  understanding  my  residents  and  seeing  them   holistically.”  (P12)  

 “It’s  a  very  handy  tool  for  me,  and  it’s  a  very  good  experience…helping   to   get   to   know   the   residents.   Normally   we   find   details   like   drug   allergies   or   little   intolerances   on   the   interRAI   rather   than   in   the   discharge  letter…and  about  the  family  histories…and  little  things  that   may  affect  the  residents.“  (P7)  

 “It  gives  you  the  knowledge  how  to  look  after  the  residents  and  what  is   expected  there.”  (P10)  

“The  positive  side  is  that  it’s  really  handy  to  trace  the  resident’s  past   history.  If  you  look  at  the  interRAI  and  who  ever  completed  it  before,   you   will   find   a   lot   of   detail   that   you   may   have   missed   out   from   discharge  letter…so  that’s  good.”  (P7)  

“It  will  benefit  them  because  they  all  have  the  same  assessments,  then   you   can   compare   them   easily,   like   you   can   actually   make   a   graph   about  it,  because  everybody  is  doing  the  same  assessment.  Unlike  if  you   don’t  have  the  same  assessment,  how  do  you  know  if  it  works?  Because   it’s  not  the  same,  you  know.  I  think  it  benefits  them.”  (P6)  

InterRAI-­‐LTCF   was   also   perceived   as   useful   when   there   was   a   change   in   a   resident’s   condition,   and   the   level   of   care   needed   to   be   reviewed   by   NASC.   InterRAI-­‐LTCF   output   scores   assist   in   the   decision   of   placing   a   resident   in   the   appropriate  level  of  care  in  rest  home,  hospital  or  dementia  unit.    

“It   indicates   to   us   if   they   are   at   the   right   level   of   care.   That’s   what   I   have   noticed.   Especially   after   it’s   all   done…The   CHESS  2  _{scores.   And}  

then  when  you  go  back  and  look  at  why  they  had  that  score,  it  opens   your  eyes  a  bit,  that  I  need  to  do  something.”  (P12)  

“The   NASC   people   call   me:   Resident   A   appears   to   be   needing   more   cares.  And  I  tell  them,  yes,  I  already  updated  the  interRAI,  you  can  look   at   it.   And   they   look   at   it,   and   they   go   to   the   geriatrician…The   geriatrician  will  ask  the  NASC  assessor  to  do  everything,  and  they  will   be  moved  to  other  place.  Very  useful  for  us  in  New  Zealand.  In  moving   to  another  facility.”  (P9)  

Some   RNs   recognised   the   value   in   collecting   data   for   research   and   statistical   purposes.    

“We  are  collecting  data,  who  doesn’t  want  data?  The  future  is  all  about   collecting  data.  You  could  do  miracles  if  you  have  information  in  your   hands.   If   there’s   no   information,   nobody   can   do   anything.   Maybe   we   can’t  see  the  fruits  right  now,  but  it’s  really  useful  in  next  few  years.”   (P8)    

“Everything   will   have   its   own   positives   and   negatives,   we   can’t   just   ignore  that  looking  at  a  few  negatives,  that  interRAI  is  waste  of  time,  I  

wouldn’t   say   that.   It   is   a   useful   thing   what   we   are   doing.   Maybe   not   useful  for  me  now  right  away,  but  it  might  be  useful  in  future.”  (P8)    

RNs  appreciated  a  shared  interRAI  database  that  is  used  nation-­‐wide,  and  which   enabled  multidisciplinary  approach.    

“Besides   the   fact   that   it   takes   time,   sometimes,   that   you   have   to   actually   make   time   for   it.   Overall   it’s   useful,   and   everybody   is   on   the   same  page,  and  we  understand  all  the  assessments.”  (P6)  

“We’re  using  the  same  software,  we’re  using  the  same  code,  so  it  will  be   very  easy  for  us  to  know  their  past  medical  conditions  and  easier  for  us   to  understand  their  conditions.  Before  you  know  the  resident  well,  you   can’t  do  a  proper  care  plan  for  the  residents.”  (P7)    

 “InterRAI   is   a   very   good   tool   where   no   part   of   the   person’s…like   elimination…physical,   mental,   spiritual…everything   is   assessed   there,   and  then  in  the  end  you  create  a  care  plan  according  to  that.  I’m  not   the  only  one  assessing  the  resident.  The  staff…my  activities  people,  the   kitchen   people   are   involved…physiotherapist   are   there,   GPs   input   is   there.  They  get  the  best  possible  care,  nothing  is  missed.”  (P10)  

In   some   companies   using   interRAI-­‐LTCF   meant   a   reduction   in   paperwork   and  streamlining  processes.  

“Everything   is   in   one   neat   package,   and   it   eliminates   all   those   assessment  forms  we  used  to  use.”  (P5)  

“It’s   a   good   general   assessment,   without   having   to   pull   out   four   different  things  to  do.  I  actually  like  the  whole  system,  because  before  

we  had  probably  five  or  six  different  sets  of  stuff  we  had  to  fill  in,  now   it’s  just  all  in  one.”  (P1)