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.
目的: 描述基于指南的多因素干预的实施过程和保真度的两个版本, 以减少养老院的身体约束, 并确定可能解释不同集群之间效应异质性的因素。 设计: 实施过程的混合方法评估 (剂量注射、剂量接收、反应和适应) 以及一项实用的三组群集随机对照试验。 方法: 在研究期间 (2015年2月至2017年2月) 收集了定量和定性的过程数据。采用描述性统计方法对问卷调查和短期调查的定量数据进行分析。采用内容分析法对来自焦点小组和半结构化访谈的定性数据进行分析。通过对比有反应和无反应的群体, 对干预目标和主要结果进行了深入分析。 结果: 这两项干预措施都按照计划在所有集群实施: 我们没有发现违反与剂量注射和接受有关的草案的情况。干预措施所针对的工作人员满意度很高。深入的分析并没有揭示在集群中实施或采用的程度有任何显著差异, 对干预或解释不同研究效果的因素的反应良好或几乎没有反应。 结论: 虽然以指南为基础的以预防养老院身体约束的多因素干预措施的两个版本均按计划实施, 且反应总体上是可以接受的, 该干预措施的目标是将护理实践转变为最低限度的约束政策, 但并不是所有组别的全体护理人员都实现了这一目标。没有任何因素可以解释干预的不同效果。 影响: 针对某些养老院, 可能需要采取除处理护士态度和机构政策以外的方法, 以便可持续地减少使用身体约束; 然而, 过程评估没有揭示可能阻碍或促进干预有效性的特征。.
Keywords: complex intervention; dementia; mixed methods; nursing; nursing homes; physical restraints; process evaluation.
© 2020 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.