Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
Nursing Research Unit, Institute of Social Medicine & Epidemiology, University of Lübeck, Lübeck, Germany.
J Adv Nurs. 2021 Mar;77(3):1465-1477. doi: 10.1111/jan.14694. Epub 2020 Dec 3.
To describe the implementation process and fidelity of two versions of a guideline-based, multicomponent intervention to reduce physical restraints in nursing homes and to identify factors that might explain the heterogeneity of effects between different clusters.
Mixed methods evaluation of the implementation process (dose delivered, dose received, response, and adaption) alongside a pragmatic three-arm cluster randomized controlled trial.
Quantitative and qualitative process data were collected during the study period (February 2015-February 2017). Quantitative data from questionnaires and short surveys were analysed by descriptive statistics. Qualitative data from focus groups and semi-structured interviews were analysed using content analysis. An in-depth analysis was conducted by contrasting responding and non-responding clusters regarding the intervention goal and primary outcome.
Both interventions were implemented as planned in all clusters: we found no deviations from the protocol regarding the dose delivered to and received by the clusters. Satisfaction of staff targeted by the interventions was high. The in-depth analysis did not reveal any pronounced variation in the degree of implementation or adoption in clusters with a good or nearly no response to the interventions or factors explaining different study effects.
Although both versions of a guideline-based multicomponent intervention to prevent physical restraints in nursing homes were implemented as planned and the response was generally acceptable, the interventions' goal to change nursing practice towards a least-restraint policy was not achieved by the entire nursing staff in all of the clusters. No factors could be identified that might explain the different effects of the interventions.
For some nursing homes, different approaches than addressing nurses' attitudes and institutional policies might be needed to sustainably reduce the use of physical restraints; however, the process evaluation did not reveal characteristics that might have hampered or facilitated the effectiveness of the intervention.
描述一种基于指南的多组分干预措施在减少养老院身体约束方面的实施过程和保真度，并确定可能解释不同群组之间效果异质性的因素。
对实施过程（剂量输送、剂量接收、反应和适应）进行混合方法评估，同时进行实用的三臂聚类随机对照试验。
在研究期间（2015 年 2 月至 2017 年 2 月）收集了定量和定性的过程数据。通过描述性统计分析来自问卷和简短调查的定量数据。使用内容分析对来自焦点小组和半结构化访谈的定性数据进行分析。通过对比干预目标和主要结果的反应和非反应群组进行深入分析。
两种干预措施都按计划在所有群组中实施：我们没有发现任何偏离协议的情况，即没有偏离向群组输送和接收的剂量。干预对象的工作人员对干预措施的满意度很高。深入分析没有发现任何明显的实施或采用程度的变化，无论是对干预措施反应良好还是几乎没有反应的群组，也没有发现任何可以解释不同研究效果的因素。
尽管基于指南的多组分干预措施预防养老院身体约束的两种版本都按计划实施，并且反应总体上是可以接受的，但干预措施的目标是改变护理实践，以实现最少约束政策，并没有被所有群组的整个护理人员实现。没有发现可以解释干预措施不同效果的因素。
对于一些养老院来说，可能需要采取不同于解决护士态度和机构政策的方法，才能可持续地减少身体约束的使用；然而，过程评估并没有揭示可能阻碍或促进干预效果的特征。
