Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr 17, 81377, Munich, Germany.
Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany.
BMC Geriatr. 2020 Aug 5;20(1):270. doi: 10.1186/s12877-020-01655-z.
Joint contractures in frail older people are associated with serious restrictions in participation. We developed the Participation Enabling CAre in Nursing (PECAN) intervention, a complex intervention to enable nurses to promote participation in nursing home residents with joint contractures. The aim of this study was to examine the feasibility of the implementation strategy and to identify enablers and barriers for a successful implementation.
The implementation of PECAN was investigated in a 6-month pilot cluster-randomised controlled trial (c-RCT). As a key component of the implementation strategy, nominated nurses were trained as facilitators in a one-day workshop and supported by peer-mentoring (visit, telephone counselling). A mixed-methods approach was conducted in conjunction with the pilot trial and guided by a framework for process evaluations of c-RCTs. Data were collected using standardised questionnaires (nursing staff), documentation forms, problem-centred qualitative interviews (facilitators, therapists, social workers, relatives, peer-mentors), and a group discussion (facilitators). A set of predefined criteria on the nursing home level was examined. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using directed content analysis.
Seven nursing homes (n = 4 intervention groups, n = 3 control groups) in two regions of Germany took part in the study. Facilitators responded well to the qualification measures (workshop participation: 14/14; workshop rating: "good"; peer-mentor visit participation: 10/14). The usage of peer-mentoring via telephone varied (one to seven contacts per nursing home). Our implementation strategy was not successful in connection with supplying the intervention to all the nurses. The clear commitment of the entire nursing home and the respect for the expertise of different healthcare professionals were emphasised as enablers, whereas a lack of impact on organisational conditions and routines and a lack of time and staff competence were mentioned as barriers.
The PECAN intervention was delivered as planned to the facilitators but was unable to produce comprehensive changes in the nursing homes and subsequently for the residents. Strategies to systematically include the management and the nursing team from the beginning are needed to support the facilitators during implementation in the main trial.
German clinical trials register, DRKS00010037 . Registered 12 February 2016.
虚弱老年人的关节挛缩与参与度严重受限有关。我们开发了参与促进护理（PECAN）干预措施，这是一种复杂的干预措施，旨在使护士能够促进有关节挛缩的养老院居民参与。本研究的目的是检验实施策略的可行性，并确定成功实施的促成因素和障碍。
在一项为期 6 个月的试点整群随机对照试验（c-RCT）中研究了 PECAN 的实施情况。作为实施策略的一个关键组成部分，指定的护士在为期一天的研讨会上接受了培训，并由同伴指导（访问、电话咨询）提供支持。采用混合方法与试点试验同时进行，并遵循 c-RCT 过程评估框架。使用标准化问卷（护理人员）、文件表格、以问题为中心的定性访谈（促进者、治疗师、社会工作者、亲属、同伴导师）和小组讨论（促进者）收集数据。还检查了一套针对养老院层面的预设标准。使用描述性统计对定量数据进行分析。使用定向内容分析对定性数据进行分析。
德国两个地区的 7 家养老院（n=4 个干预组，n=3 个对照组）参与了这项研究。促进者对资格措施反应良好（研讨会参与率：14/14；研讨会评分：“良好”；同伴导师访问参与率：10/14）。通过电话进行同伴指导的使用情况有所不同（每个养老院一到七个联系）。我们的实施策略未能成功地将干预措施提供给所有护士。整个养老院的明确承诺和对不同医疗保健专业人员专业知识的尊重被强调为促成因素，而对组织条件和常规的影响有限以及缺乏时间和员工能力被提及为障碍。
PECAN 干预措施按计划提供给了促进者，但未能在养老院及其随后为居民带来全面变化。需要从一开始就制定系统地包括管理层和护理团队的策略，以在主要试验中为促进者提供实施支持。
德国临床试验注册处，DRKS00010037。2016 年 2 月 12 日注册。
