Implementation of a complex intervention to improve participation in older people with joint contractures living in nursing homes: A process evaluation of a cluster-randomised pilot trial

Abstract

Background Joint contractures in frail older people are associated with serious restrictions in participation. We developed the Participation Enabling CAre in Nursing (PECAN) intervention, a complex intervention to enable nurses to promote participation in nursing home residents with joint contractures. The aim of this study was to examine the feasibility of the implementation strategy and to identify enablers and barriers for a successful implementation. Methods The implementation of PECAN was investigated in a 6-month pilot cluster-randomised controlled trial (c-RCT). As a key component of the implementation strategy, nominated nurses were trained as facilitators in a one-day workshop and supported by peer-mentoring (visit, telephone counselling). A mixed-methods approach was conducted in conjunction with the pilot trial and guided by a framework for process evaluations of c-RCTs. Data were collected using standardised questionnaires (nursing staff), documentation forms, problem-centred qualitative interviews (facilitators, therapists, social workers, relatives, peer-mentors), and a group discussion (facilitators). A set of predefined criteria on the nursing home level was examined. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using directed content analysis. Results Seven nursing homes (n=4 intervention groups, n=3 control groups) in two German regions took part in the study. Facilitators responded well to the qualification measures (workshop participation: 14/14; workshop rating: “good”; peer-mentor visit participation: 10/14). The usage of peer-mentoring via telephone varied (one to seven contacts per nursing home). Our implementation strategy was not successful in connection with supplying the intervention to all the nursing staff. The clear commitment of the entire nursing home and the respect for the expertise of different healthcare professionals were emphasised as enablers, whereas a lack of impact on organisational conditions and routines and a lack of time and staff competence were mentioned as barriers. Conclusion The PECAN intervention was delivered as planned to the facilitators but was unable to produce comprehensive changes in the nursing homes and subsequently for the residents. Strategies to systematically include the management and the nursing team from the beginning, are needed to support the facilitators during implementation in the main trial.

Factors Associated with Development of New Joint Contractures in Long-Term Care Residents

“…Second, implementation of a restorative nursing care approach including educating and training health care staff to promote residents' functional independence in daily activities will be a useful way to apply regular stretching as part of the residents' active and daily routines. 3,6,22,27 Facility-acquired contracture rate is considered a measure of the quality of care of nursing homes in some countries, including the United States. It has been shown that the level and quality of staffing, facility structure, and funding sources explain a large proportion of the disparity of facility-acquired contracture rates in nursing homes.…”

Improving mobility and participation of older people with vertigo, dizziness and balance disorders in primary care using a care pathway: feasibility study and process evaluation

“…Despite the health professionals' enthusiasm for the telephone helpline, its utilisation was low, maybe a contact on a regular basis might be bene cial [62].…”