Introducing a nursing guideline on depression in dementia: A multiple case study on influencing factors

Verkaik, Renate; Francké, Anneke L.; Meijel, Berno van; Ouwerkerk, Jessika; Ribbe, Miel W.; Bensing, J.M.

doi:10.1016/j.ijnurstu.2011.02.009

Cited by 23 publications

(40 citation statements)

References 15 publications

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“…Studies of complex interventions have shown that influencing factors can occur at several levels [ 23 24 25 ]; the organisational level, the team level, and the individual resident/professional level. For example, some studies [ 25 26 27 28 ] described staff turnover, high workload, concurrent projects, and/or organisational changes as barriers for implementing care innovations. The presence of an opinion leader or support of key persons, and a positive attitude towards change, have been described as facilitating factors in the implementation of an intervention [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Implementation of a Stepwise, Multidisciplinary Intervention for Pain and Challenging Behaviour in Dementia (STA OP!): A Process Evaluation

Pieper¹,

Achterberg²,

Steen³

et al. 2018

International Journal of Integrated Care

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Background:A stepwise, multidisciplinary and multicomponent intervention (called STA OP!) was implemented in Dutch nursing home units, which included a comprehensive multidisciplinary team training. A cluster-randomised controlled trial showed that the intervention reduced symptoms of pain and challenging behaviour.Objective(s):To describe the experiences around the implementation of the intervention; to examine the extent to which the STA OP! intervention was delivered and implemented as intended (at the level of the team, and the individual resident/professional); and to understand factors influencing the implementation process.Methods:A process evaluation was performed using a mixed-methods design encompassing several data sources. Quantitative data (i.e. from the written evaluations by healthcare professionals, management, and the research database) were analysed using descriptive statistics. Qualitative data (i.e. semi-structured interviews, notes, completed intervention forms, and written evaluations) were analysed according to the principles of thematic analysis. The implementation process and the influencing factors were categorised according to the i) organisational level, ii) the team level, and iii) the level of the individual resident/professional.Results:In total, 39.2% of the residents with pain and/or challenging behaviour were treated following the stepwise approach of the STA OP! intervention. The training manual and forms used were found to be relevant and feasible. Factors inhibiting the implementation process at the i) organisational level concerned instability of the organisation and the team (e.g. involvement in multiple projects/new innovations, staff turnover/absence of essential disciplines, and/or high workload). At the team level (ii), we found that presence of a person with a motivational leadership style facilitated the implementation. Also, interdisciplinary cooperation through the design/setting of the multidisciplinary training, securing the intervention by use of clear agreements, and written reporting or transfers facilitated implementation. At the individual level (iii), perceived value of the stepwise working method, and enhanced awareness facilitated the implementation.Conclusion:Although the intervention was not implemented as planned, the intervention empowered healthcare professionals and increased their awareness of the signals of pain and challenging behaviour. Future implementation of the intervention should start on units with a motivational leader, and specific features of the organisation and the team should be considered to facilitate implementation, e.g. stability, support, and shared focus to change.

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Section: Introductionmentioning

confidence: 99%

Implementation of a Stepwise, Multidisciplinary Intervention for Pain and Challenging Behaviour in Dementia (STA OP!): A Process Evaluation

Pieper¹,

Achterberg²,

Steen³

et al. 2018

International Journal of Integrated Care

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“…A first step in a systematic implementation process is the identification of barriers and facilitators [ 7 ]. Recent studies have provided some insights in possible barriers and facilitators related to changing the organization of other fields in health care, for example, in the handover of care [ 8 ], case management [ 9 ] and the introduction of nursing guidelines [ 10 ]. However, studies on improving the organization of palliative care are still lacking.…”

Section: Introductionmentioning

confidence: 99%

Improving the organization of palliative care: identification of barriers and facilitators in five European countries

Paap¹,

Vernooij‐Dassen²,

Brouwer³

et al. 2014

Implementation Sci

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BackgroundInterventions to improve palliative care encounter challenges beyond the usual implementation problems because of palliative care’s complex and changing character. In this study, we explored barriers and facilitators faced by health-care professionals in five European countries (England, Germany, Italy, Norway and the Netherlands) with regard to improving the organization of their palliative care service.MethodsSemi-structured individual and focus group interviews were conducted with purposefully selected health-care professionals. The constant comparative method was used to analyse the data.ResultsProfessionals working in hospitals, hospices, nursing homes and primary care facilities who provide palliative care to adult patients were interviewed (n =40) or participated in ten focus group interviews (n =59). Barriers and facilitators were inductively grouped into 16 categories and arranged into five themes: innovation, individual professional level, group dynamics, organizational context and local political-economic context. Although the barriers and facilitators identified differed in scope, context, strength and provenance, they were shared by professionals from different European countries.ConclusionThis study identified barriers and facilitators to organizational change in palliative care. Some of these barriers and facilitators were experienced by professionals in almost all countries and are therefore prerequisites to change. Understanding the barriers to and facilitators of change will help tailor organizational improvements to the needs of individuals and organizations.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0130-z) contains supplementary material, which is available to authorized users.

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“…In addition, a major barrier reported was the high turnover of the nursing home workforce [14][15][16][17][18][19]. Moreover, reorganizations, other innovations running at the time of the intervention, absent feeling of relevance by the staff [8,17,18,20] and the culture of the care unit, including attitude towards change, are barriers towards changing current practice [14].…”

Section: Introductionmentioning

confidence: 99%

The construction of a framework explaining the relation between barriers to change in nursing homes: a qualitative study

Teunenbroek¹,

Verhagen

Smalbrugge

et al. 2019

Preprint

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Background Many studies have tried to achieve change in the treatment of neuropsychiatric symptoms in nursing homes, however only few of them succeeded. Numerous barriers to change were identified, yet only one conceptual model is known to study the relationships between these barriers in healthcare. Unfortunately, this model does not discuss specific barriers encountered in nursing home practice. The aim of this study is to explore perceived barriers to change in nursing home organizations and to construct a framework providing insight into the relative importance of and the relationships between these barriers with regard to improving quality of care.Methods In order to explore the barriers to change in nursing home care, four focus groups were conducted in different dementia special care units of one nursing home in the Netherlands, with a specific focus on NPS and psychotropic drug use. Participants were either nursing staff, treatment staff or relatives of residents. Qualitative thematic analysis was conducted according to the five phases constructed by Braun & Clarke. Finally, a conceptual framework showing the interrelations of themes was defined using text fragments of the focus groups.Results We constructed a framework consisting of eight themes of barriers explaining the extent to which change can be achieved: 'organizational barriers', 'personal barriers', 'deficiency of knowledge', 'suboptimal communication', 'inadequate (multidisciplinary) collaboration', 'disorganization of processes', 'reactive coping' and 'differences in perception'. Addressing 'organizational barriers' and a 'deficiency of knowledge' is a precondition for change. 'Suboptimal communication' and 'inadequate (multidisciplinary) collaboration' play a key role in the extent of change achieved via the themes 'differences in perception' and 'disorganization of processes'. Furthermore, 'personal barriers' influence all themes - except 'organizational barriers' - and influence the extent of change. 'Personal barriers' can cause 'reactive coping', which in turn may lead to 'difficulties t structure processes'.Conclusions A framework was created explaining the relationships between barriers towards achieving change in nursing homes, focused on improving quality of care. This framework can be used to study the interrelatedness of barriers to change, and to determine the importance of addressing it in order to achieve change in the provided care.

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Introducing a nursing guideline on depression in dementia: A multiple case study on influencing factors

Cited by 23 publications

References 15 publications

Implementation of a Stepwise, Multidisciplinary Intervention for Pain and Challenging Behaviour in Dementia (STA OP!): A Process Evaluation

Implementation of a Stepwise, Multidisciplinary Intervention for Pain and Challenging Behaviour in Dementia (STA OP!): A Process Evaluation

Improving the organization of palliative care: identification of barriers and facilitators in five European countries

The construction of a framework explaining the relation between barriers to change in nursing homes: a qualitative study

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