目的:评估在临终关怀中对家庭照顾者实施照顾者支持需求评估工具干预的失败,在使用归一化过程理论(NPT)的试验背景下。
方法:进行了一项评估研究,以从我们的试验中吸取教训,这是不成功的,由于参加人数少。评估研究利用了各种数据源,包括访谈和问卷调查中公布的数据,以及来自电子邮件和谈话笔记的未发布数据。
方法:回顾性收集数据。专题分析是在《不扩散条约》框架的指导下进行的。该框架强调,干预的成功实施依赖于其“正常化”,由四个结构组成:连贯性,认知参与,集体行动和反身监测。
结果:连贯性(意义):护士认为干预措施有助于他们评估家庭护理人员需求的能力,但是有些人不确定它与通常的做法有何不同。认知参与(关系工作):护士冠军在建立实践社区中起着至关重要的作用。然而,由于员工更替和短缺,维持这个社区是一项挑战。集体行动(为进行干预所做的工作):护士认为护理人员支持需求评估工具培训使他们能够改善对家庭护理人员的支持。然而,上下文因素复杂的实施,例如习惯于患者而不是以家庭为中心的方法和高工作量。反射性监测(干预评估):护士在干预中的积极经验促使他们实施干预。然而,由于参与的潜在负担,研究背景使得护士在招募家庭护理人员时犹豫不决.
结论:尽管该干预措施显示出帮助护士为家庭护理人员提供量身定制的支持的潜力,它融入日常实践并不是最优的。情境因素,例如以患者为中心的护理方法和研究背景,阻碍了干预的正常化。
■需要评估和考虑可能影响复杂护理干预实施的环境因素。《不扩散核武器条约》为评估我们研究中的执行过程提供了宝贵的框架。
结论:这项研究解决了什么问题?这项评估研究分析了促进或阻碍实施护理干预措施以支持家庭护理人员进行临终关怀的因素。主要发现是什么?干预和干预培训对于护士在为家庭护理人员提供量身定制的支持方面都具有潜力和价值。然而,由于组织因素和研究背景,实施面临挑战,包括招聘。研究将在何处以及对谁产生影响?这种见解对于参与实施复杂护理干预措施的所有利益相关者来说都是有价值的,包括研究人员,护士和资助者。
■本研究遵循了相关的EQUATOR指南:报告定性研究标准(SRQR)。
■没有患者或公众参与。
背景:该试验在荷兰试验登记册(NL7702)上进行了前瞻性注册。
OBJECTIVE: To evaluate the failed implementation of the Carer Support Needs Assessment Tool Intervention for family caregivers in end-of-life care, within a
trial context using Normalization Process Theory (NPT).
METHODS: An evaluation
study was conducted to learn lessons from our
trial, which was not successful due to the low number of participants. The evaluation study utilized various data sources, including published data from interviews and questionnaires, and unpublished data derived from emails and conversation notes.
METHODS: Data were retrospectively collected. Thematic analysis was conducted guided by the NPT framework. This framework emphasizes that successful implementation of an intervention relies on its \'normalization\', consisting of four constructs: coherence, cognitive participation, collective action and reflexive monitoring.
RESULTS: Coherence (sense making): Nurses felt the intervention could contribute to their competence in assessing family caregivers\' needs, but some were unsure how it differed from usual practice. Cognitive participation (relational work): Nurse champions played a crucial role in building a community of practice. However, sustaining this community was challenging due to staff turnover and shortages. Collective action (work done to enable the intervention): Nurses felt the Carer Support Needs Assessment Tool training enabled them to improve their support of family caregivers. However, contextual factors complicated implementation, such as being used to a patient rather than a family-focused approach and a high workload. Reflexive monitoring (appraisal of the intervention): Positive experiences of the nurses with the intervention motivated them to implement it. However, the research context made nurses hesitant to recruit family caregivers because of the potential burden of participation.
CONCLUSIONS: Although the intervention demonstrated potential to assist nurses in providing tailored support to family caregivers, its integration into daily practice was not optimal. Contextual factors, such as a patient-focused approach to care and the research context, hampered normalization of the intervention.
UNASSIGNED: Assessing and considering contextual factors that may influence implementation of a complex care intervention is needed. The NPT provided a valuable framework for evaluating the implementation process in our
study.
CONCLUSIONS: What problem did the
study address? This evaluation study analysed the factors that promoted or hindered the implementation of a nursing intervention to support family caregivers in end-of-life care. What were the main findings? Both the intervention and the intervention training have potential and value for nurses in providing tailored support to family caregivers. However, the implementation faced challenges due to organizational factors and the research context, including recruitment. Where and on whom will the research have an impact? This insight is valuable for all stakeholders involved in implementing complex nursing interventions, including researchers, nurses and funders.
UNASSIGNED: This study has adhered to the relevant EQUATOR guidelines: Standards for Reporting Qualitative Research (SRQR).
UNASSIGNED: There was no patient or public involved.
BACKGROUND: The
trial was prospectively registered on the Dutch
Trial Register (NL7702).