Research Health Scientist, Durham VA Health Care System, and Assistant Professor, Department of Population Health Sciences, Duke University, Durham, NC, USA.
Postdoctoral Research Fellow, Margolis Center for Health Policy, Duke University, Durham, NC, USA.
J Nurs Scholarsh. 2020 Jan;52(1):23-33. doi: 10.1111/jnu.12511. Epub 2019 Sep 9.
We describe an approach to rapidly adapt and implement an education and skills improvement intervention to address the needs of family caregivers of functionally impaired veterans-Helping Invested Families Improve Veterans' Experience Study (HI-FIVES).
Prior to implementation in eight sites, a multidisciplinary study team made systematic adaptations to the curriculum content and delivery process using input from the original randomized controlled trial (RCT); a stakeholder advisory board comprised of national experts in caregiver education, nursing, and implementation; and a veteran/caregiver engagement panel. To address site-specific implementation barriers in diverse settings, we applied the Replicating Effective Programs implementation framework.
Adaptations to HI-FIVES content and delivery included identifying core/noncore curriculum components, reducing instruction time, and simplifying caregiver recruitment for clinical settings. To enhance curriculum flexibility and potential uptake, site personnel were able to choose which staff would deliver the intervention and whether to offer class sessions in person or remotely. Curriculum materials were standardized and packaged to reduce the time required for implementation and to promote fidelity to the intervention.
The emphasis on flexible intervention delivery and standardized materials has been identified as strengths of the adaptation process. Two key challenges have been identifying feasible impact measures and reaching eligible caregivers for intervention recruitment.
This systematic implementation process can be used to rapidly adapt an intervention to diverse clinical sites and contexts. Nursing professionals play a significant role in educating and supporting caregivers and care recipients and can take a leading role to implement interventions that address skills and unmet needs for caregivers.
我们描述了一种快速适应和实施教育和技能提升干预措施的方法，以满足功能障碍退伍军人的家庭照顾者的需求-帮助投入家庭改善退伍军人的体验研究（HI-FIVES）。
在八个地点实施之前，一个多学科研究小组使用原始随机对照试验（RCT）的投入、由 caregiver 教育、护理和实施方面的国家专家组成的利益相关者顾问委员会以及退伍军人/照顾者参与小组，对课程内容和交付过程进行了系统的调整。为了解决不同环境中的特定地点实施障碍，我们应用了复制有效计划实施框架。
HI-FIVES 内容和交付的调整包括确定核心/非核心课程组件、减少教学时间以及简化临床环境中的照顾者招募。为了增强课程的灵活性和潜在的接受度，现场人员可以选择谁来提供干预措施，以及是否亲自或远程提供课程。课程材料进行了标准化和打包，以减少实施所需的时间并促进干预措施的一致性。
强调灵活的干预措施交付和标准化材料被认为是适应过程的优势。两个关键挑战是确定可行的影响衡量标准和为干预措施招募合格的照顾者。
这个系统的实施过程可以用于快速适应不同的临床地点和环境的干预措施。护理专业人员在教育和支持照顾者和护理接受者方面发挥着重要作用，可以在实施解决照顾者技能和未满足需求的干预措施方面发挥主导作用。
