Jacobsen Frode F, Mekki Tone Elin, Førland Oddvar, Folkestad Bjarte, Kirkevold Øyvind, Skår Randi, Tveit Eva Marie, Øye Christine
Center for Care Research, Western Norway, Bergen, Norway.
Western Norway University of Applied Sciences, P.O.Box 7030, N-5020 Bergen, Norway.
BMC Nurs. 2017 Sep 18;16:55. doi: 10.1186/s12912-017-0244-0. eCollection 2017.
People living with dementia in nursing homes are most likely to be restrained. The primary aim of this mixed-method education intervention study was to investigate which factors hindered or facilitated staff awareness related to confidence building initiatives based on person-centred care, as an alternative to restraint in residents with dementia in nursing homes. The education intervention, consisting of a two-day seminar and monthly coaching sessions for six months, targeted nursing staff in 24 nursing homes in Western Norway. The present article reports on staff-related data from the study.
We employed a mixed-method design combining quantitative and qualitative methods. The P-CAT (Person-centred Care Assessment Tool) and QPS-Nordic (The General Nordic questionnaire for psychological and social factors at work) instruments were used to measure staff effects in terms of person-centred care and perception of leadership. The qualitative data were collected through ethnographic fieldwork, qualitative interviews and analysis of 84 reflection notes from eight persons in the four teams who facilitated the intervention. The PARIHS (Promoting Action on Research Implementation in Health Services) theoretical framework informed the study design and the data analysis. Six nursing homes were selected for ethnographic study post-intervention.
Qualitative data indicated increased staff awareness related to using restraint - or not- in the context of person-centered care. A slight increase in P-CAT supported these findings. Thirteen percent of the P-CAT variation was explained by institutional belonging. Qualitative data indicated that whether shared decisions of alternative measures to restraint were applied was a function of dynamic interplay between facilitation and contextual elements. In this connection, the role of the nursing home leaders appeared to be a pivotal element promoting or hindering person-centered care. However, leadership-staff relations varied substantially across individual institutions, as did staff awareness related to restraint and person-centeredness.
Leadership, in interplay with staff culture, turned out to be the most important factor hindering or promoting staff awareness related to confidence building initiatives, based on person-centered care. While quantitative data indicated variations across institutions and the extent of this variation, qualitative data offered insight into the local processes involved. A mixed method approach enabled understanding of dynamic contextual relationships.
The trial is registered at Clinical Trials gov. reg. 2012/304 NCT01715506.
养老院中患有痴呆症的人最有可能受到约束。这项混合方法教育干预研究的主要目的是调查哪些因素阻碍或促进了工作人员对基于以人为本护理的信心建设举措的认识，以此作为养老院中痴呆症患者约束替代方案。教育干预包括为期两天的研讨会和为期六个月的每月辅导课程，目标是挪威西部24家养老院的护理人员。本文报告了该研究中与工作人员相关的数据。
我们采用了结合定量和定性方法的混合方法设计。使用以人为本护理评估工具（P-CAT）和北欧工作心理和社会因素通用问卷（QPS-Nordic）来衡量工作人员在以人为本护理和领导感知方面的效果。定性数据通过人种志实地调查、定性访谈以及对四个促进干预的团队中八个人的84篇反思笔记进行分析来收集。促进卫生服务研究实施行动（PARIHS）理论框架为研究设计和数据分析提供了指导。干预后选择了六家养老院进行人种志研究。
定性数据表明，工作人员在以人为本护理背景下对使用或不使用约束的认识有所提高。P-CAT的轻微增加支持了这些发现。P-CAT变异的13%可由机构归属来解释。定性数据表明，是否采用约束替代措施的共同决策是促进因素和背景因素之间动态相互作用的结果。在这方面，养老院领导的作用似乎是促进或阻碍以人为本护理的关键因素。然而，领导与工作人员的关系在各个机构之间差异很大，与约束和以人为本相关的工作人员意识也是如此。
事实证明，领导与工作人员文化的相互作用是阻碍或促进工作人员对基于以人为本护理的信心建设举措认识的最重要因素。虽然定量数据表明各机构之间存在差异以及这种差异的程度，但定性数据提供了对所涉及的当地过程的洞察。混合方法使我们能够理解动态的背景关系。
该试验已在Clinical Trials gov注册。注册号：2012/304 NCT01715506。
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