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养老院内预防身体约束的多因素干预过程评价(IMPRINT) : 一项混合方法研究
Author(s) -
Abraham Jens,
Bake Mareike,
BergerHöger Birte,
Köpke Sascha,
Kupfer Ramona,
Meyer Gabriele,
Möhler Ralph
Publication year - 2021
Publication title -
journal of advanced nursing
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.948
H-Index - 155
eISSN - 1365-2648
pISSN - 0309-2402
DOI - 10.1111/jan.14694
Subject(s) - psychological intervention , guideline , fidelity , intervention (counseling) , nursing , cluster (spacecraft) , protocol (science) , descriptive statistics , qualitative property , nursing interventions classification , medicine , cluster randomised controlled trial , qualitative research , psychology , computer science , alternative medicine , telecommunications , social science , statistics , mathematics , pathology , machine learning , sociology , programming language
Aims To describe the implementation process and fidelity of two versions of a guideline‐based, multicomponent intervention to reduce physical restraints in nursing homes and to identify factors that might explain the heterogeneity of effects between different clusters. Design Mixed methods evaluation of the implementation process (dose delivered, dose received, response, and adaption) alongside a pragmatic three‐arm cluster randomized controlled trial. Methods Quantitative and qualitative process data were collected during the study period (February 2015–February 2017). Quantitative data from questionnaires and short surveys were analysed by descriptive statistics. Qualitative data from focus groups and semi‐structured interviews were analysed using content analysis. An in‐depth analysis was conducted by contrasting responding and non‐responding clusters regarding the intervention goal and primary outcome. Results Both interventions were implemented as planned in all clusters: we found no deviations from the protocol regarding the dose delivered to and received by the clusters. Satisfaction of staff targeted by the interventions was high. The in‐depth analysis did not reveal any pronounced variation in the degree of implementation or adoption in clusters with a good or nearly no response to the interventions or factors explaining different study effects. Conclusion Although both versions of a guideline‐based multicomponent intervention to prevent physical restraints in nursing homes were implemented as planned and the response was generally acceptable, the interventions' goal to change nursing practice towards a least‐restraint policy was not achieved by the entire nursing staff in all of the clusters. No factors could be identified that might explain the different effects of the interventions. Impact For some nursing homes, different approaches than addressing nurses' attitudes and institutional policies might be needed to sustainably reduce the use of physical restraints; however, the process evaluation did not reveal characteristics that might have hampered or facilitated the effectiveness of the intervention.