Evaluating the use of participatory action research to implement evidence‐based guidance on dementia palliative care in long‐term care settings: A creative hermeneutic analysis

Abstract

Background Dementia affects a large proportion of society and places a significant burden on older people and healthcare systems internationally. Managing symptoms at the end of life for people with dementia is complex. Participatory action research can offer an approach that helps to encourage implementation of evidence‐based practices in long‐term care settings. Methods Three evidence‐based guidance documents (pain assessment and management, medication management, nutrition and hydration management) were introduced in three long‐term care settings for older people. Data generated from work‐based learning groups were analysed using a critical hermeneutic approach to explore the use of participatory action research to support the implementation of guidance documents in these settings. Results Engagement and Facilitation emerged as key factors which both enabled and hindered the PAR processes at each study site. Conclusions This study adds to the body of knowledge that emphasises the value of participatory action research in enabling practice change. It further identifies key practice development approaches that are necessary to enable a PAR approach to occur in care settings for older people with dementia. The study highlights the need to ensure that dedicated attention is paid to strategies that facilitate key transformations in clinical practice.

Initiatives Targeting Health Care Professionals

“…In KM studies for HCPs, program adherence was only reported when deviations from intended delivery occurred. Deviations occurred to better accommodate staff schedules, promote uptake and as a result of time constraints 17,53,75 . Technology barriers greatly impacted adherence in one study, forcing a transition from web-delivered modules to paper copies 41 …”

“…Penetration is the reach or integration of an intervention into a service setting 25 . Penetration was examined in 2 KT-I programs; 75,97 target outcomes partially improved in both studies. After a guideline initiative, 76.4% of nurses trained reported familiarity with program information for nursing home resident pain, indicating education reached and was attended to by a majority of nurses 79 .…”

“…Deviations occurred to better accommodate staff schedules, promote uptake and as a result of time constraints. 17,53,75 Technology barriers greatly impacted adherence in one study, forcing a transition from web-delivered modules to paper copies. 41 Adherence to recommended documentation practices was considered in 11 HCP-directed initiatives.…”

Factors that influence the implementation of innovation in aged care: a scoping review

“…Of the 2530 retrieved studies, 193 were ultimately included 6,7,11–201 . The PRISMA-ScR diagram (Figure 1) shows the study selection process and reasons for full-text exclusion.…”

Evaluating the process of practice enhancement for exclusive breastfeeding (PEEB): a participatory action research approach for clinical innovation

“…It involves stakeholders as active participants in the research process, not merely as 'subjects' but as co-researchers. It is an approach that is responsive and committed in providing solutions to real world problems [37] and has been particularly valuable in health and social care research in providing crucial insights into the barriers and facilitators of implementing evidence-based practices and expanding understanding of complex situations [38][39][40]. Workplace learning is a core feature of many action-oriented approaches such as participatory research and includes an emphasis on experiential learning [41,42] and facilitation of critical reflection in the creation of new professional knowledge [43,44].…”