Direct observations of nursing home care quality: Does care change when observed?

J Am Med Dir Assoc. 2006 Nov;7(9):541-4. doi: 10.1016/j.jamda.2006.03.009. Epub 2006 May 30.


Objectives: Recent research demonstrates that care recorded by nursing home (NH) staff is often inaccurate. Direct observations of care may therefore be of critical importance in assessing and improving care in this setting. Unfortunately, despite their apparent use in several types of quality assurance activities, there is little written information about the reliability or accuracy of observational procedures in NHs. This paper provides information about one important measurement issue (reactivity) that is often cited as a limitation of observational procedures in measuring usual care practices accurately.

Design: Descriptive.

Setting: Seven nursing homes.

Participants: Staff and residents.

Measurements: Direct observational time in bed; repositioning and feeding assistance.

Results: Observational measures of care quality were stable over multiple observation periods and consistently detected quality problems even on the first and last days of observation.

Conclusion: Direct observations of care provided to residents do not appear to change provider behavior.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Attitude of Health Personnel
  • Bed Rest / nursing
  • Bed Rest / standards
  • Behavior
  • Bias
  • Clinical Protocols
  • Data Collection / methods
  • Data Collection / standards*
  • Effect Modifier, Epidemiologic
  • Health Services Research / methods
  • Health Services Research / standards*
  • Humans
  • Medical Audit / methods
  • Medical Audit / standards
  • Nursing Assistants / psychology
  • Nursing Assistants / standards
  • Nursing Homes* / standards
  • Nursing Staff / psychology
  • Nursing Staff / standards
  • Nutritional Support / nursing
  • Nutritional Support / standards
  • Observation* / methods
  • Posture
  • Quality Assurance, Health Care
  • Quality of Health Care* / standards
  • Time Factors
  • Total Quality Management