School of Physical Therapy, The University of Western Ontario, London, Ontario, Canada.
Arthur Labatt Family School of Nursing, The University of Western Ontario, London, Ontario, Canada.
Gerontologist. 2023 Mar 21;63(3):478-489. doi: 10.1093/geront/gnac154.
Government-mandated health and safety restrictions to mitigate the effects of coronavirus disease 2019 (COVID-19) intensified challenges in caring for older adults in long-term care (LTC) without family/care partners. This article describes the experiences of a multidisciplinary research team in implementing an evidence-based intervention for family-centered, team-based, virtual care planning-PIECESTM approach-into clinical practice. We highlight challenges and considerations for implementation science to support care practices for older adults in LTC, their families, and the workforce.
A qualitative descriptive design was used. Data included meetings with LTC directors and Registered Practical Nurses (i.e., licensed nurse who graduated with a 2-year diploma program that allows them to provide basic nursing care); one-on-one interviews with family/care partners, residents, Registered Practical Nurses, and PIECES mentors; and reflections of the academic team. The Consolidated Framework for Implementation Research provided sensitizing constructs for deductive coding, while an inductive approach also allowed themes to emerge.
Findings highlighted how aspects related to planning, engagement, execution, reflection, and evaluation influenced the implementation process from the perspectives of stakeholders. Involving expert partners on the research team to bridge research and practice, developing relationships from a distance, empowering frontline champions, and adapting to challenging circumstances led to shared commitments for intervention success.
Lessons learned include the significance of stakeholder involvement throughout all research activities, the importance of clarity around expectations of all team members, and the consequence of readiness for implementation with respect to circumstances (e.g., COVID-19) and capacity for change.
为减轻 2019 年冠状病毒病（COVID-19）的影响，政府强制实施了健康和安全限制，这给没有家属/护理伙伴的长期护理（LTC）中的老年人护理带来了更大的挑战。本文描述了一个多学科研究团队在将基于证据的以家庭为中心、团队为基础、虚拟护理计划-PIECESTM 方法实施到临床实践中的经验。我们强调了实施科学的挑战和注意事项，以支持 LTC 中的老年人、他们的家属和劳动力的护理实践。
采用定性描述性设计。数据包括与 LTC 主任和注册护士（即，从为期 2 年的大专课程毕业的持照护士，他们可以提供基本的护理服务）的会议；与家属/护理伙伴、居民、注册护士和 PIECES 导师的一对一访谈；以及学术团队的反思。实施研究综合框架为演绎编码提供了敏感结构，而归纳方法也允许主题出现。
研究结果强调了规划、参与、执行、反思和评估等方面如何从利益相关者的角度影响实施过程。在研究团队中引入专家合作伙伴以弥合研究与实践之间的差距，建立远程关系，赋予一线冠军权力，并适应具有挑战性的环境，这些都促成了对干预成功的共同承诺。
经验教训包括在所有研究活动中利益相关者参与的重要性，所有团队成员期望明确的重要性，以及在考虑到情况（例如 COVID-19）和变革能力的情况下实施的准备情况的重要性。
