Implementation Outcomes for the SLUMBER Sleep Improvement Program in Long-Term Care

Joshua Chodosh; Mary Cadogan; Abraham A Brody; Michael N Mitchell; Diana E Hernandez; Michael Mangold; Cathy A Alessi; Yeonsu Song; Jennifer L Martin

doi:10.1016/j.jamda.2024.02.004

Implementation Outcomes for the SLUMBER Sleep Improvement Program in Long-Term Care

J Am Med Dir Assoc. 2024 Mar 14:S1525-8610(24)00133-6. doi: 10.1016/j.jamda.2024.02.004. Online ahead of print.

Authors

Joshua Chodosh¹, Mary Cadogan², Abraham A Brody³, Michael N Mitchell⁴, Diana E Hernandez⁵, Michael Mangold⁶, Cathy A Alessi⁷, Yeonsu Song⁸, Jennifer L Martin⁷

Affiliations

¹ Department of Medicine, New York University Grossman School of Medicine, New York City, NY, USA; Medicine Service, VA New York Harbor Healthcare System, New York City, NY, USA. Electronic address: Joshua.chodosh@nyumc.org.
² School of Nursing, University of California, Los Angeles, CA, USA.
³ Department of Medicine, New York University Grossman School of Medicine, New York City, NY, USA; Hartford Institute for Geriatric Nursing, Rory Meyers College of Nursing, New York University, New York City, NY, USA.
⁴ Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
⁵ Department of Medicine, New York University Grossman School of Medicine, New York City, NY, USA.
⁶ Department of Psychiatry, Icahn School of Medicine at Mount Sinai (Beth Israel), New York City, New York, USA.
⁷ Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
⁸ School of Nursing, University of California, Los Angeles, CA, USA; Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.

PMID: 38493806
DOI: 10.1016/j.jamda.2024.02.004

Abstract

Objectives: To describe the implementation of a mentored staff-delivered sleep program in nursing facilities.

Design: Modified stepped-wedge unit-level intervention.

Setting and participants: This program was implemented in 2 New York City nursing facilities, with partial implementation (due to COVID-19) in a third facility.

Methods: Expert mentors provided staff webinars, in-person workshops, and weekly sleep pearls via text messaging. We used the integrated Promoting Action on Research Implementation in Health Services (i-PARiHS) framework as a post hoc approach to describe key elements of the SLUMBER implementation. We measured staff participation in unit-level procedures and noted their commentary during unit workshops.

Results: We completed SLUMBER within 5 units across 2 facilities and held 15 leadership meetings before and during program implementation. Sessions on each unit included 3 virtual webinar presentations and 4 in-person workshops for each nursing shift, held over a period of 3 to 4 months. Staff attendance averaged >3 sessions per individual staff member. Approximately 65% of staff present on each unit participated in any given session. Text messaging was useful for engagement, educational reinforcement, and encouraging attendance. We elevated staff as experts in the care of their residents as a strategy for staff engagement and behavior change and solicited challenging cases from staff during workshops to provide strategies to address resident behavior and encourage adoption when successful.

Conclusions and implications: Engaging staff, leadership, residents, and family of nursing facilities in implementing a multicomponent sleep quality improvement program is feasible for improving nursing facilities' sleep environment. The program required gaining trust at multiple levels through presence and empathy, and reinforcement mechanisms (primarily text messages). To improve scalability, SLUMBER could evolve from an interdisciplinary investigator-based approach to internal coaches in a train-the-trainer model to effectively and sustainably implement this program to improve sleep quality for facility residents.

Keywords: Sleep; depression; implementation; quality improvement; skilled nursing facilities.

Published by Elsevier Inc.

Abstract

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