Vluggen Stan, Metzelthin Silke, Lima Passos Valeria, Zwakhalen Sandra, Huisman-de Waal Getty, de Man-van Ginkel Janneke
Department of Health Services Research, Maastricht University, Care and Public Health Research Institute, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands.
Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands.
BMC Nurs. 2022 May 19;21(1):121. doi: 10.1186/s12912-022-00902-5.
Nurses are in a key position to stimulate older people to maximize their functional activity and independence. However, nurses still often work in a task-oriented manner and tend to take over tasks unnecessarily. It is evident to support nurses to focus on the capabilities of older people and provide care assistance only when required. Function-Focused Care (FFC) is a holistic care-philosophy aiming to support nurses to deliver care in which functioning and independence of older people is optimized. Dutch and internationally developed FFC-based interventions often lack effectiveness in changing nurses' and client's behavior. Process-evaluations have yielded lessons and implications resulting in the development of an advanced generic FFC-program: the 'SELF-program'. The SELF-program aims to improve activity stimulation behavior of nurses in long-term care services, and with that optimize levels of self-reliance in activities of daily living (ADL) in geriatric clients. The innovative character of the SELF-program lies for example in the application of extended behavior change theory, its interactive nature, and tailoring its components to setting-specific elements and needs of its participants. This paper describes the outline, content and theoretical background of the SELF-program. Subsequently, this paper describes a protocol for the assessment of the program's effect, economic and process-evaluation in a two-arm (SELF-program vs care as usual) multicenter cluster-randomized trial (CRT).
The proposed CRT has three objectives, including getting insight into the program's: (1) effectiveness regarding activity stimulation behavior of nurses and self-reliance in ADL of geriatric clients, and (2) cost-effectiveness from a societal perspective including assessments of quality of life and health-care use. Measurements will take place prior to program implementation (baseline), directly after (T1), and in long-term (T2). Parallel to the CRT, a process evaluation will be conducted to provide insight into the program's: (3) feasibility regarding implementation, mechanisms of impact and contextual factors.
The SELF-program was developed following the Medical Research Council framework, which addresses the systematic development, feasibility testing, evaluation and implementation of complex interventions. The program has been subjected to a feasibility study before and results of studies described in this protocol are expected to be available from end 2022 onwards.
TRIAL-REGISTRATION: The study is registered in the Dutch Trial Register ( NL9189 ), as of December 22 2020.
护士在激励老年人最大限度地发挥其功能活动和独立性方面处于关键地位。然而，护士仍常常以任务为导向开展工作，并且往往会不必要地接管任务。显然，应支持护士关注老年人的能力，仅在必要时提供护理协助。功能聚焦护理（FFC）是一种整体护理理念，旨在支持护士提供能优化老年人功能和独立性的护理。荷兰及国际上开发的基于FFC的干预措施在改变护士和患者行为方面往往缺乏成效。过程评估得出了经验教训和启示，促成了一个先进的通用FFC项目的开发：“自我项目”。“自我项目”旨在改善长期护理服务中护士的活动激励行为，从而优化老年患者日常生活活动（ADL）中的自理水平。“自我项目”的创新性体现在例如扩展行为改变理论的应用、其互动性质以及根据特定环境因素和参与者需求调整其组成部分等方面。本文描述了“自我项目”的概述、内容和理论背景。随后，本文描述了在双臂（“自我项目”组与常规护理组）多中心整群随机试验（CRT）中评估该项目效果、经济性和过程评估的方案。
拟进行的CRT有三个目标，包括深入了解该项目的：（1）对护士活动激励行为和老年患者ADL自理能力的有效性，以及（2）从社会角度的成本效益，包括对生活质量和医疗保健使用的评估。测量将在项目实施前（基线）、实施后立即（T1）以及长期（T2）进行。与CRT并行，将进行过程评估，以深入了解该项目的：（3）实施可行性、影响机制和背景因素。
“自我项目”是按照医学研究理事会框架开发的，该框架涉及复杂干预措施的系统开发、可行性测试、评估和实施。该项目此前已进行过可行性研究，本方案中描述的研究结果预计从2022年底起可得。
该研究于2020年12月22日在荷兰试验注册库（NL9189）注册。
