Clarke David J, Hawkins R, Sadler E, Harding G, McKevitt C, Godfrey M, Dickerson J, Farrin A J, Kalra L, Smithard D, Forster A
Bradford Teaching Hospitals NHS Trust and University of Leeds, Bradford, UK.
BMJ Open. 2014 Apr 15;4(4):e004473. doi: 10.1136/bmjopen-2013-004473.
To evaluate the process of implementation of the modified London Stroke Carers Training Course (LSCTC) in the Training Caregivers After Stroke (TRACS) cluster randomised trial and contribute to the interpretation of the TRACS trial results. The LSCTC was a structured competency-based training programme designed to help develop the knowledge and skills (eg, patient handling or transfer skills) essential for the day-to-day management of disabled survivors of stroke. The LSCTC comprised 14 components, 6 were mandatory (and delivered to all) and 8 non-mandatory, to be delivered based on individual assessment of caregiver need.
Process evaluation using non-participant observation, documentary analysis and semistructured interviews.
Patients with stroke (n=38), caregivers (n=38), stroke unit staff (n=53).
10 of the 36 stroke units participating in the TRACS trial in four English regions (Yorkshire, North West, South East and South West, Peninsula).
Preparatory cascade training on delivery of the LSCTC did not reach all staff and did not lead to multidisciplinary team (MDT) wide understanding of, engagement with or commitment to the LSCTC. Although senior therapists in most intervention units observed developed ownership of the LSCTC, MDT working led to separation rather than integration of delivery of LSCTC elements. Organisational features of stroke units and professionals' patient-focused practices limited the involvement of caregivers. Caregivers were often invited to observe therapy or care being provided by professionals but had few opportunities to make sense of, or to develop knowledge and stroke-specific skills provided by the LSCTC. Where provided, caregiver training came very late in the inpatient stay. Assessment and development of caregiver competence was not commonly observed.
Contextual factors including service improvement pressures and staff perceptions of the necessity for and work required in caregiver training impacted negatively on implementation of the caregiver training intervention. Structured caregiver training programmes such as the LSCTC are unlikely to be practical in settings with short inpatient stays. Stroke units where early supported discharge is in place potentially offer a more effective vehicle for introducing competency based caregiver training.
ISRCTN49208824.
评估改良版伦敦卒中护理者培训课程（LSCTC）在卒中后护理者培训（TRACS）整群随机试验中的实施过程，并协助解读TRACS试验结果。LSCTC是一个基于能力的结构化培训项目，旨在帮助培养卒中残疾幸存者日常管理所必需的知识和技能（如患者处理或转移技能）。LSCTC由14个部分组成，其中6个是强制性的（并提供给所有人），8个是非强制性的，根据护理者需求的个体评估进行提供。
采用非参与性观察、文献分析和半结构化访谈进行过程评估。
卒中患者（n = 38）、护理者（n = 38）、卒中单元工作人员（n = 53）。
参与TRACS试验的36个卒中单元中的10个，分布在英国四个地区（约克郡、西北部、东南部和西南部半岛）。
关于LSCTC实施的预备级联培训并未覆盖所有工作人员，也未使多学科团队（MDT）对LSCTC有广泛的理解、参与或投入。尽管大多数干预单元的高级治疗师观察到LSCTC的自主性有所提高，但MDT工作导致LSCTC各要素的实施出现分离而非整合。卒中单元的组织特征和专业人员以患者为中心的做法限制了护理者的参与。护理者经常被邀请观察专业人员提供的治疗或护理，但很少有机会理解或培养LSCTC提供的知识和卒中特定技能。在提供护理者培训的地方，培训在住院后期才进行。护理者能力的评估和培养并不常见。
包括服务改进压力以及工作人员对护理者培训必要性和所需工作的认知等背景因素，对护理者培训干预的实施产生了负面影响。像LSCTC这样的结构化护理者培训项目在住院时间较短的环境中不太可能切实可行。实施早期支持出院的卒中单元可能为引入基于能力的护理者培训提供更有效的途径。
相关TRACS整群随机对照试验编号：ISRCTN49208824
