Evaluating the context within which continence care is provided in rehabilitation units for older people

Abstract

Aim. This paper presents the first phase of an all Ireland 2-year study between the University of Ulster and University College Cork, to determine the contextual indicators that enable or hinder person centred continence care and management in rehabilitation settings for older people. The primary outcome of the study was the development of a tool to enable practitioners to assess the practice context within which continence care is provided. The main focus of this paper is the value of understanding practice 'context' (culture, leadership and evaluation) and its impact to the provision of person centred continence care. Background. The literature highlights the effect of continence problems on the quality of life of older people. Incontinence is often seen by health care professionals and older people as an inevitable consequence of ageing and difficult to treat. Furthermore, health care professionals do not always have the necessary skills and knowledge of best practice in continence care and treatments. The Promoting Action on Research Implementation in Health Services (PARIHS) framework utilized in the study proposes that successful implementation of evidence in practice is dependent on the inter-relationship of three key elements; the nature of the evidence, the quality of the context and expert facilitation. Kitson et al. propose that for successful implementation, evidence needs to be robust, the context receptive to change and appropriate facilitation is needed. Consequently understanding practice 'context' and its impact on the provision of person centred continence care is of value. Methods. Case study methodology with several data collection methods was utilized to measure all aspects of 'context' as identified by the PARIHS framework. Methods include: Royal College of Physicians Audit Scheme, Staff Knowledge questionnaire, semi-structured observation of practice and multidisciplinary focus groups. Findings. The data were analysed in two stages. Stage 1 using both qualitative and quantitative (SPSS 12) methods. Stage 2 analysed all the data utilizing the characteristics of context from the PARIHS framework in order to identify the strong and weak characteristics of the context within which continence care was provided. Continence care and management in this study was found to be focused on continence containment rather than proactive management. The evidence suggests that the context (leadership, culture and evaluation) was weak and not conducive to person centred continence care and management. Conclusion. An analysis of the data using the context framework provided a picture of the context within the units and the identification of the specific contextual issues hindering and enabling the delivery of person centred continence care. This process has thus, added to our understanding of the importance of context to the provision of person-centred care.

A critical synthesis of literature on the promoting action on research implementation in health services (PARIHS) framework

“…These were written by members of a PARIHS coordinating group (http://www.PARIHS.org/pages/contact_us.html) for the stated purpose of introducing [3] or elaborating on the framework, either as a whole [7,15], or on one of its three core elements [4-6]. The remaining 18 articles (Table 2 Overview of empirical articles included in the synthesis) were a mix of case reports and qualitative or mixed-methods studies [27-33], quantitative studies [9-11,34-36], literature reviews [37-39] and study protocols [40] or frameworks [41]. We refer to these collectively as empirical articles to distinguish them from the core concept articles.…”

“…Two of the empirical articles reported on the same study in which the Context Assessment Instrument (CAI) was developed based on PARIHS [35,36]. We also obtained an unpublished final report for the project [42], which included all of the material in the two articles plus more methodological detail.…”

“…Three empirical papers described development of survey instruments based on PARIHS, two exclusively on the same survey assessing the element of context [35,36] and the other on evidence and context [11]. A series of three studies mapped survey items from secondary datasets to PARIHS elements, and tested their association with nurses' RU: one focused on context [34], and two on context and facilitation [9,10].…”

Monitoring and managing metabolic effects of antipsychotics: a cluster randomized trial of an intervention combining evidence-based quality improvement and external facilitation

“…This instrument was developed for use in VA treatment settings, assessing organizational readiness in terms of PARIHS domains of evidence, context and facilitation, as well as the sub-elements of culture and leadership [47,48]. The 15- to 20-minute survey was administered to all provider participants at the 12 participating sites during the Pre-implementation Phase and will be repeated at the conclusion of the Sustainability Phase.…”

Development and assessment of the Alberta Context Tool

“…This closely resembles 'transformational leadership'[11], a broad term reflecting leaders thought to be among the most effective leaders because they are able to transpose their ideas and beliefs into collective beliefs which eventually become assumptions and part of a unit's culture [11-13]. Emotionally intelligent leadership styles are one form of leadership consistent with transformational styles because they focus on how leaders manage their own emotions and their relationships with others both individually and in larger social settings [14].…”