FC35: The use of narrative approaches to improve quality of care in the long-term care setting: a scoping review

Abstract

Objectives: Experienced quality of care of older people using long term care is not sufficiently reflected in quantitative quality measures, like surveys or indicators. Therefore, care organizations increasingly use narrative approaches to collect and analyze experiences of clients, relatives, and professionals with quality of care. These Methods enable care organizations to share experiences, identify dilemmas in care provision and provide rich information for quality improvement. However, information about such Methods is scattered. The aim of this scoping review is to explore which types of narrative approaches are used for quality improvement in the long- term care setting for older people. The review identifies, among other things, types of narrative approaches, their goal and challenges.

Methods: A literature search (in Embase, Medline ALL, Web of Science Core Collection, CINAHL, PsycINFO, Sociological Abstracts – proquest, Social Services Abstracts, International Bibliography of the Social Sciences, Google Scholar) was performed from inception up to 28th of April 2022. Thirty-nine articles were included.

Results: Almost all included studies were from Western countries, in particular the Netherlands and Canada, and much focused on intramural care. Different types of narrative approaches were identified, such as a participatory or co-design, photovoice or interview approach. The goal of the approaches was directed at the client, care relationship, organization, or a combination of those levels. The agenda for quality improvement was usually informed by insights revealed during the execution of the narrative approach and researchers were often leading this process. Most approaches are used in practice only once at one or more locations. Findings and suggestions for further research will be discussed, for example about including people with cognitive impairments or relatives.

Conclusions: This scoping review revealed a variety of approaches that attempt to collect narrative information from older people, relatives, and professionals to improve quality of long- term care. Development opportunities for narrative approaches are structural embedding of narrative approaches in practice, including people with (severe) cognitive problems, and effect studies about achieved improvements.