Center for Care Research, Western Norway University of Applied Sciences, Bergen, Norway.
Center for institutional and home care services, Hordaland, Norway.
J Adv Nurs. 2017 Nov;73(11):2622-2632. doi: 10.1111/jan.13340. Epub 2017 Jun 13.
To explore the inter-play between external facilitation and nursing home contexts relative to intervention outcomes.
The Promoting Action on Research Implementation in Health Services framework is frequently used to theoretically inform implementation and research in nursing and recent reviews indicate high face validity for health services. However, the inter-play and relationship between framework sub-elements of evidence, context and facilitation and the prospective utility in non-English speaking contexts warrant further illumination.
In an overarching single-blind cluster-randomized controlled trial, we applied participatory action research and ethnography from August 2011-June 2015 to evaluate a standardized education intervention to reduce restraint and agitation in nursing home residents living with dementia. The trial results are published elsewhere.
Prospectively informed by the PARIHS framework, a research team and eight facilitators participating in dual roles as action researchers designed, implemented, and evaluated the intervention. How contextual factors influenced the facilitation processes were explored in focus group interviews (1), reflection notes (84) written by the facilitators' after each education session, ethnographic field studies (6 homes), and co-analysis workshops (5). Directed content analysis was used to analyse data.
Clinical leaders taking roles of internal facilitator influenced the success of implementation, while complex and fluctuating context elements determined whether restraint use was reduced- or not. The PARIHS framework was found to be relevant in a non-English nursing home setting, albeit some elements merit further conceptualization.
Our findings confirm the prospective utility of the PARIHS framework for implementation in a non-English context, particularly the notion of implementation processes as dynamic and multifaceted.
探讨外部促进因素与养老院环境之间的相互作用与干预结果的关系。
促进卫生服务中实施行动的研究（Promoting Action on Research Implementation in Health Services，PARIHS）框架经常被用于为护理实施和研究提供理论依据，最近的综述表明该框架在卫生服务方面具有较高的表面有效性。然而，框架的证据、背景和促进因素的各个子要素之间的相互作用和关系，以及在非英语环境中的预期效用，仍需要进一步阐明。
在一项总体的单盲集群随机对照试验中，我们从 2011 年 8 月至 2015 年 6 月应用参与式行动研究和民族志学，评估了一项标准化教育干预措施，以减少患有痴呆症的养老院居民的约束和激越行为。试验结果已在其他地方发表。
前瞻性地受 PARIHS 框架的启发，一个研究团队和 8 名促进者以行动研究人员的双重角色参与设计、实施和评估干预措施。通过焦点小组访谈（1 次）、促进者在每次教育课程后撰写的反思笔记（84 份）、民族志实地研究（6 个养老院）和共同分析研讨会（5 次），探讨了环境因素对促进过程的影响。采用定向内容分析法分析数据。
担任内部促进者角色的临床领导对实施的成功产生了影响，而复杂和波动的环境因素决定了约束使用是否减少。发现 PARIHS 框架在非英语养老院环境中具有相关性，尽管有些要素需要进一步概念化。
我们的研究结果证实了 PARIHS 框架在非英语环境中实施的前瞻性效用，特别是实施过程是动态和多方面的这一概念。
