Review of stepped-wedge trial on Montessori approaches for nursing home staff during COVID-19

BACKGROUND AND OBJECTIVES: We describe nursing home staff perspectives implementing Montessori approaches to person-centered care (MAP-VA) in Veterans Administration Community Living Centers (CLCs) during the coronavirus disease 2019 (COVID-19) pandemic We investigated. staff perspectives on implementing MAP-VA to promote resident autonomy, engagement, and connection in the context of pandemic-related safety precautions. RESEARCH DESIGN AND METHODS: We used longitudinal data from a stepped-wedge, randomized clinical trial examining implementation and effectiveness of MAP-VA. Implementation support included 5 weeks during pre-implementation, staff MAP-VA training, 6 months each of implementation facilitation, and sustainment support. Normalization Process Theory informed data collection and analyses. Staff (N = 1,117) from 8 CLCs participated. No site was COVID-19 free: All sites except one experienced at least 1 month where 5% or more of residents were infected; 1 site experienced rates of 16%. We completed individual or group interviews with 162 staff, at baseline, 3, 6, 9, and 12 months between September 2021 and October 2023. We coded transcripts using content analysis and graphed COVID-19 rates over 18 months during implementation. RESULTS: We identified 4 themes related to implementing MAP-VA during the pandemic: The waves of COVID-19 and changing precautions were associated with (a) barriers to Veteran engagement and connection; (b) staffing-related barriers to implementation; and during COVID, MAP-VA was a positive force that (c) increased Veteran wellbeing; and (d) improved staff morale. DISCUSSION AND IMPLICATIONS: Results indicate that supporting person-centered care in nursing home settings is possible-and perhaps even protective for staff and residents-during crises and periods of increased safety concerns. CLINICAL TRIAL REGISTRATION NUMBER: NCT04829500.