Date on Paper


Document Type

Doctoral Paper

Degree Name




Committee Chair

Harrington, Candace

Committee Member

Skinner, Mary

Author's Keywords

geriatrics; value-based care; interprofessional; ethnocultural


Background/Significance: Providers may unknowingly impede residents’ equitable treatment without understanding ethnocultural diversity and values, thus preventing residents and their families from receiving care consistent with residents’ values and beliefs.

Purpose: This project aimed to improve equitable healthcare with spiritual and ethnocultural congruence integrated into care processes and workflow in a skilled nursing facility.

Methods: The Institute of Healthcare Improvement model for improvement (MFI) and an adapted evidence-based practice guideline guided the quality improvement project, implemented in one section of a 60-bed long-term care unit at a skilled nursing facility.

Practice Change: Process and care delivery workflow changes included three aims: (1) resident and family members' satisfaction with value-based care processes, (2), staff and providers' acceptability and usability and (3) implementation compliance were analyzed and revised with three rapid quality improvement cycles.

Results: Aim one was exceeded with a 28.5% positive percentage of change in resident satisfaction with mental well-being assessment and consideration from baseline to week four and a 14.3% positive percentage of change in resident satisfaction with mental well-being assessment at week eight. Aim two, to exceed the 70% benchmark for acceptability and useability of the care process changes, was met (83%) at week eight. Aim three was exceeded with a 166.7% positive change noted in the provider administration of the adopted assessments at week eight.

Implications: The project leader demonstrated quality improvement for value-based resident-centered care processes and workflows is possible and improves equitable care in long-term care settings.

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Nursing Commons