Roets-Merken Lieve M, Vernooij-Dassen Myrra J F J, Zuidema Sytse U, Dees Marianne K, Hermsen Pieter G J M, Kempen Gertrudis I J M, Graff Maud J L
Radboud University Medical Center, Donders Center for Cognition, Brain & Behavior, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands.
Kalorama Foundation, Beek-Ubbergen, The Netherlands.
BMJ Open. 2016 Nov 17;6(11):e013122. doi: 10.1136/bmjopen-2016-013122.
To gain insights into the process of nurses' changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care, and into the factors that contributed to these changes in their perceptions.
Qualitative study alongside a cluster randomised controlled trial.
17 long-term care homes spread across the Netherlands.
34 licensed practical nurses supporting 54 dual sensory impaired older adults.
A 5-month training programme designed to enable nurses to support the self-management of dual sensory impaired older adults in long-term care.
Nurses' perceptions on relevance and feasibility of the self-management programme collected from nurses' semistructured coaching diaries over the 5-month training and intervention period, as well as from trainers' reports.
Nurses' initial negative perceptions on relevance and feasibility of the intervention changed to positive as nurses better understood the concept of autonomy. Through interactions with older adults and by self-evaluations of the effect of their behaviour, nurses discovered that their usual care conflicted with client autonomy. From that moment, nurses felt encouraged to adapt their behaviour to the older adults' autonomy needs. However, nurses' initial unfamiliarity with conversation techniques required a longer exploration period than planned. Once client autonomy was understood, nurses recommended expanding the intervention as a generic approach to all their clients, whether dual sensory impaired or not.
Longitudinal data collection enabled exploration of nurses' changes in perceptions when moving towards self-management support. The training programme stimulated nurses to go beyond 'protocol thinking', discovering client autonomy and exploring the need for their own behavioural adaptations. Educational programmes for practical nurses should offer more longitudinal coaching of autonomy supportive conversational skills. Intervention programming should acknowledge that change is a process rather than an event, and should include self-evaluations of professional behaviours over a period of time.
NCT01217502, Post-results.
深入了解护士在接受培训以实施针对长期护理中双重感官受损老年人的自我管理计划时，其观念转变的过程，以及促成这些观念变化的因素。
定性研究与整群随机对照试验相结合。
荷兰各地的17所长期护理院。
34名执业护士，为54名双重感官受损的老年人提供支持。
一项为期5个月的培训计划，旨在使护士能够支持长期护理中双重感官受损老年人的自我管理。
在为期5个月的培训和干预期内，从护士的半结构化指导日记以及培训师的报告中收集护士对自我管理计划的相关性和可行性的看法。
随着护士对自主性概念的更好理解，他们最初对干预措施的相关性和可行性的负面看法转变为积极看法。通过与老年人的互动以及对自身行为效果的自我评估，护士发现他们通常的护理方式与患者的自主性相冲突。从那时起，护士们受到鼓舞，根据老年人的自主性需求调整自己的行为。然而，护士最初对沟通技巧的不熟悉使得探索期比计划的更长。一旦理解了患者的自主性，护士们建议将该干预措施扩展为适用于所有患者的通用方法，无论其是否存在双重感官受损。
纵向数据收集有助于探索护士在转向自我管理支持时观念的变化。培训计划促使护士超越“照章行事思维”，发现患者的自主性并探索自身行为调整的必要性。针对执业护士的教育计划应提供更多关于自主性支持性沟通技巧的纵向指导。干预计划应认识到改变是一个过程而非一个事件，并且应包括一段时间内对专业行为的自我评估。
NCT01217502，结果公布后。
