Evidence Summary

What is an Evidence Summary?

Key messages from scientific research that's ready to be acted on

Got It, Hide this
  • Rating:

Older adults may receive better care in nursing homes when staff actively push for quality improvements

Woo K, Milworm &, Dowding D. Characteristics of quality improvement champions in nursing homes: A systematic review with implications for evidence-based practice Worldviews on evidence-based nursing. 2017;14(6):440-446.

Review Question

  • Which nursing-home staff should actively push for quality improvement, what role should they play and how should they be trained?


  • With an aging population, there is an urgent need to improve the quality of care provided to nursing-home residents and reduce the costs associated with care.
  • Promising quality-improvement efforts have found that involving and empowering nursing-home staff such as nurses or nursing assistants to push for change can improve patient outcomes.
  • This study explores which nursing-home staff could actively push for quality improvements, how they can support change and what kind of training would be needed to enable them to do so.

How the review was done

  • A detailed search of a number of electronic databases for studies published from 1946 to 2016 was conducted. Studies that focused on quality-improvement initiatives that involved empowering nurses and nursing assistants were included in the review.
  • A total of 337 studies were identified in searches, and seven were included in the review after assessments for eligibility.
  • This review was funded by Elderly Health Promotions Inc. and the National Institute of Nursing Research.

What the researchers found

  • Studies showed inconsistency regarding who should actively push for quality improvement in nursing homes. Staff who were involved included nursing assistants who were less educated, nurses, as well as senior managers.
  • The roles of staff in encouraging change were found to be complex and inconsistent. However, education, role models and resources to remind staff of best practices were found to be helpful.
  • The review found that it was unclear what specific education or training staff need in order to actively push for changes in nursing homes. Those involved may have different educational backgrounds, so it is important to identify common skill sets through further research.


  • The review found that various nursing-home staff may successfully encourage improvements in quality. Studies were inconsistent regarding what quality improvement tasks staff should perform, as well as which staff are ideal for the role. Further research is needed to determine the common skill sets and training required to support those who can actively push for quality improvements in nursing homes.

Related Web Resources

  • Dementia in long-term care

    Canadian Institute for Health Information
    Older adults with dementia may need to move into long-term care homes if they can no longer stay at home. These people have higher risk of getting physically restrained or given antipsychotic medication. Changes to policy and education have made these things happen less often.
  • Treating pressure ulcers: New evidence, continued uncertainty

    Evidently Cochrane
    Gauze dressings should not be used to treat pressure ulcers (bed sores). Other options include alginate dressings, hydrogel dressings, and negative pressure wound therapy. More evidence is needed about which options are best to improve pain and reduce complications. Research should measure outcomes that matter to patients and carers as well as health professionals.
  • Patient education: Delirium (Beyond the Basics)

    UpToDate - patient information
    Delirium is the result of brain changes that lead to confusion, lack of focus and memory problems. There is no specific treatment for delirium - it is best to avoid risks, treat underlying illnesses and receive supportive care. Sedatives and physical restraints should be avoided.
DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (

Register for free access to all Professional content