测试功能聚焦护理在辅助生活环境中的实施情况。
Testing the Implementation of Function-focused Care in Assisted Living Settings.
机构信息
University of Maryland School of Nursing, Baltimore, MD, USA.
College of Nursing, Pennsylvania State University, University Park, PA, USA.
出版信息
J Am Med Dir Assoc. 2021 Aug;22(8):1706-1713.e1. doi: 10.1016/j.jamda.2020.09.026. Epub 2020 Oct 31.
OBJECTIVES
The purpose of this study was to evaluate the Function-Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC-AL-EIT) intervention.
DESIGN
FFC-AL-EIT was a randomized controlled pragmatic trial including 85 sites and 794 residents.
INTERVENTION
FFC-AL-EIT was implemented by a Research Nurse Facilitator working with a facility champion and stakeholder team for 12 months to increase function and physical activity among residents. FFC-AL-EIT included (Step I) Environment and Policy Assessments; (Step II) Education; (Step III) Establishing Resident Function-Focused Care Service Plans; and (Step IV) Mentoring and Motivating.
SETTING AND PARTICIPANTS
The age of participants was 89.48 years [standard deviation (SD) = 7.43], and the majority were female (n = 561; 71%) and white (n = 771; 97%).
METHODS
Resident measures, obtained at baseline, 4, and 12 months, included function, physical activity, and performance of function-focused care. Setting outcomes, obtained at baseline and 12 months, included environment and policy assessments and service plans.
RESULTS
Reach was based on 85 of 90 sites that volunteered (94%) participating. Effectiveness was based on less decline in function (P < .001), more function-focused care (P = .012) and better environment (P = .032) and policy (P = .003) support for function-focused care in treatment sites. Adoption was supported with 10.00 (SD = 2.00) monthly meetings held, 77% of settings engaged in study activities as or more than expected, and direct care workers providing function-focused care (63% to 68% at 4 months and 90% at 12 months). The intervention was implemented as intended, and education was received based on a mean knowledge test score of 88% correct. Evidence of maintenance from 12 to 18 months was noted in treatment site environments (P = .35) and policies continuing to support function-focused care (P = .28)].
CONCLUSIONS AND IMPLICATIONS
The Evidence Integration Triangle is an effective implementation approach for assisted living. Future work should continue to consider innovative approaches for measuring RE-AIM outcomes.
目的
本研究旨在评估使用证据整合三角（FFC-AL-EIT）的功能聚焦辅助生活护理（FFC-AL-EIT）干预措施。
设计
FFC-AL-EIT 是一项随机对照实用试验，纳入了 85 个地点和 794 名居民。
干预措施
FFC-AL-EIT 由一名研究护士协调员与设施冠军和利益相关者团队合作实施 12 个月，以提高居民的功能和身体活动。FFC-AL-EIT 包括（步骤 I）环境和政策评估；（步骤 II）教育；（步骤 III）制定居民功能聚焦护理服务计划；和（步骤 IV）指导和激励。
地点和参与者
参与者的年龄为 89.48 岁[标准差（SD）=7.43]，大多数为女性（n=561；71%）和白人（n=771；97%）。
方法
居民在基线、4 个月和 12 个月时的测量指标包括功能、身体活动和功能聚焦护理的执行情况。环境和政策评估以及服务计划在基线和 12 个月时进行测量。
结果
85 个自愿参与的地点中有 85 个（94%）达到了可及性。有效性基于功能下降幅度较小（P<0.001）、更多的功能聚焦护理（P=0.012）以及更好的环境（P=0.032）和政策（P=0.003）支持治疗点的功能聚焦护理。采用率支持每月进行 10.00（SD=2.00）次会议，77%的环境参与了预期或更多的研究活动，直接护理人员提供了功能聚焦护理（4 个月时为 63%至 68%，12 个月时为 90%）。该干预措施按预期实施，根据知识测试的平均正确回答率为 88%，护理人员接受了教育。在治疗地点环境（P=0.35）和继续支持功能聚焦护理的政策（P=0.28）方面，从 12 个月到 18 个月注意到了维持的证据。
结论和意义
证据整合三角是辅助生活的有效实施方法。未来的工作应继续考虑创新的方法来衡量 RE-AIM 结果。
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