Although there are certain ‘core’ features of the TNH model, its application can be expected to vary with local conditions, the expertise brought by its partnering organisations, and the needs of students and residents. For this reason, a ‘one size fits all’ approach is not appropriate to the implementation of the model.
In reviewing different applications of the TNH model, Chilvers and Jones identified that typically the affiliation involved RACFs and either schools of nursing or schools of medicine (1997: 464), but that the method of affiliation appeared to be influenced by financial resources (citing Cifferi & Baker 1985 and Kaeser etal1989). This has been found to produce two approaches – the one with funding involving joint appointments between the RACF and education provider and the one without such resourcing adopting an exchangeapproach. These two approaches were found to predominate, but with variations to each (Budden 1994; Layng Millonig 1986).
Exchange models have tended to operate informally and with limited funding support (Chilvers & Jones
1997: 466; citing Ciferri & Baker 1985). For a period of time, faculty members may work exclusively in the RACF and a member of the RACF staff works exclusively within the faculty. Roles are clearly defined with the faculty member responsible for the care of, and generating research opportunities, from a case load. The faculty member may provide a role model and catalyst for research, but the sustainability of this role is likely to be limited once the faculty member has left the RACF (Chilvers & Jones 1997: 466; citing Wykle
& Kaufmann 1988). The main benefit of this approach is that it enables faculty members to identify
practice issues, to research these and feedback new knowledge into the education system (Chilvers & Jones 1997: 466).
Most of the TNH models involve partnerships between university schools of nursing and RACFs, but some also include acute care hospitals (which has been the model of veteran specific TNHs since the 1960s – as discussed in Section1.1.3 (Rubinstein etal:1990). See also Section1.4.1describing the Netherlands application of the TNH, which also appoints physicians as part of the RACF workforce (rather than as visiting specialists). Case Study2 - Section1.3.1,exemplifies such a collaboration and is also unique by providing specifically for the needs of residents’ families. As such the collaboration also included social work practitioners and had a stronger multidisciplinary focus than many TNHs funded by the TNHP.
Affiliates: Carroll Manor & the Catholic University of America School of Nursing, Ohio
Funder: Robert Wood Johnson Foundation Program: Teaching Nursing Home Program (TNHP)
Those involved in implementing the affiliation between Carroll Manor and the Catholic University of America School of Nursing found that six years after its initiation, the TNH project had been a catalyst for change bringing about the
Where previously attracting nursing students into aged care had been difficulty, students competed for clinical placement at Carroll Manor.
A Research and Education Committee comprising nursing home staff, residents and school of nursing faculty was established to approve proposals for student placement and for clinical research at the facility.
The focus on research had seen facility staff increasingly using scientific methods in their work and early indications that research was enhancing decision making.
This TNH model also provided for the needs of family members of residential aged care facility clients. A program known as ‘FamilyCircle’combined nursing and social work activities providing information, education and support to families. This interdisciplinary initiative also provided learning experiences for students on placement.
The collaboration was extended to include a local hospital which had provided the nursing home with greater access to a range of services, supported closer working relationships between physicians and nurse
practitioners associated with the TNH. This had the broader impact of increasing the facility’s capacity to provide skilled care than would otherwise have occurred in a hospital (Burke & Donley 1987: 37-39: Donley
Critical Success Factors
Retrospective analysis has identified these factors as being crucial to this TNHP affiliation. These factors are somewhat interdependent.
Broadening of the collaboration to includea localhospitalwhich increased access to services and supported a wider range of working relationships.
The appointmentofnursepractitionersto work with facility staff, students and physicians from local health services and the participating hospital.
Commitmentbystakeholdersatalllevels – from senior management to front line delivery and teaching staff
– to the TNH and its underpinning principles. These included valuing research and education as a means to improving nursing care of older people and supporting the rights of older people.
Expression of that commitment in a formalagreementthatspecifiedmutualresponsibilitiesandroles(Clarke