长期护理中维持复杂干预措施：对直接护理人员和管理人员的定性研究
Sustaining complex interventions in long-term care: a qualitative study of direct care staff and managers.
作者信息
Colón-Emeric Cathleen, Toles Mark, Cary Michael P, Batchelor-Murphy Melissa, Yap Tracey, Song Yuting, Hall Rasheeda, Anderson Amber, Burd Andrew, Anderson Ruth A
机构信息
Duke University School of Medicine, Box 3003 DUMC, Durham, NC, 27710, USA.
Durham VA Geriatric Research Education and Clinical Center, 508 Fulton St., Durham, NC, 27705, USA.
出版信息
Implement Sci. 2016 Jul 16;11:94. doi: 10.1186/s13012-016-0454-y.
BACKGROUND
Little is known about the sustainability of behavioral change interventions in long-term care (LTC). Following a cluster randomized trial of an intervention to improve staff communication (CONNECT), we conducted focus groups of direct care staff and managers to elicit their perceptions of factors that enhance or reduce sustainability in the LTC setting. The overall aim was to generate hypotheses about how to sustain complex interventions in LTC.
METHODS
In eight facilities, we conducted 15 focus groups with 83 staff who had participated in at least one intervention session. Where possible, separate groups were conducted with direct care staff and managers. An interview guide probed for staff perceptions of intervention salience and sustainability. Framework analysis of coded transcripts was used to distill insights about sustainability related to intervention features, organizational context, and external supports.
RESULTS
Staff described important factors for intervention sustainability that are particularly challenging in LTC. Because of the tremendous diversity in staff roles and education level, interventions should balance complexity and simplicity, use a variety of delivery methods and venues (e.g., group and individual sessions, role-play/storytelling), and be inclusive of many work positions. Intervention customizability and flexibility was particularly prized in this unpredictable and resource-strapped environment. Contextual features noted to be important include addressing the frequent lack of trust between direct care staff and managers and ensuring that direct care staff directly observe manager participation and support for the program. External supports suggested to be useful for sustainability include formalization of changes into facility routines, using "train the trainer" approaches and refresher sessions. High staff turnover is common in LTC, and providing materials for new staff orientation was reported to be important for sustainability.
CONCLUSIONS
When designing or implementing complex behavior change interventions in LTC, consideration of these particularly salient intervention features, contextual factors, and external supports identified by staff may enhance sustainability.
TRIAL REGISTRATION
ClinicalTrial.gov, NCT00636675.
背景
关于长期护理（LTC）中行为改变干预措施的可持续性，人们了解甚少。在一项旨在改善员工沟通的干预措施（CONNECT）的整群随机试验之后，我们对直接护理人员和管理人员进行了焦点小组访谈，以了解他们对长期护理环境中增强或降低可持续性的因素的看法。总体目标是提出关于如何在长期护理中维持复杂干预措施的假设。
方法
在八个机构中，我们与83名至少参加过一次干预课程的工作人员进行了15次焦点小组访谈。在可能的情况下，分别与直接护理人员和管理人员进行小组访谈。一份访谈指南探究了工作人员对干预措施显著性和可持续性的看法。对编码后的访谈记录进行框架分析，以提炼出与干预特征、组织背景和外部支持相关的可持续性见解。
结果
工作人员描述了干预措施可持续性的重要因素，这些因素在长期护理中尤其具有挑战性。由于工作人员角色和教育水平差异巨大，干预措施应在复杂性和简单性之间取得平衡，采用多种实施方法和场所（如小组和个人课程、角色扮演/讲故事），并涵盖多个工作岗位。在这个不可预测且资源紧张的环境中，干预措施的可定制性和灵活性尤为重要。被认为重要的背景特征包括解决直接护理人员和管理人员之间经常缺乏信任的问题，并确保直接护理人员直接观察到管理人员对该项目的参与和支持。被认为对可持续性有用的外部支持包括将变革正式纳入机构日常工作，采用“培训培训师”方法和复习课程。长期护理中员工流动率高很常见，为新员工入职培训提供材料对可持续性很重要。
结论
在长期护理中设计或实施复杂的行为改变干预措施时，考虑工作人员确定的这些特别显著的干预特征、背景因素和外部支持可能会提高可持续性。
试验注册
ClinicalTrial.gov，NCT00636675。
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