Abstract
BackgroundJoint 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.MethodsThe 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.ResultsSeven nursing homes (n = 4 intervention groups, n = 3 control groups) in two regions of Germany 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 nurses. 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.ConclusionThe 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.Trial registrationGerman clinical trials register, DRKS00010037. Registered 12 February 2016.
Highlights
Joint contractures in frail older people are associated with serious restrictions in participation
Four nursing homes with participating residents were randomised to the intervention group (PECAN) and three nursing homes with residents were randomised to the control group
The intervention was delivered as planned to the facilitators but was insufficient to change the professional behaviour of the whole nursing staff in most clusters, and subsequently it failed to improve the residents’ participation
Summary
Joint contractures in frail older people are associated with serious restrictions in participation. Older people living in nursing homes are often affected by joint contractures due to the association with several health conditions, immobility and age. Recent research, using the International Classification of Functioning, Disability and Health (ICF) [8] as a framework, indicates that joint contractures are associated with numerous limitations of functioning such as mobility, self-care, sensory function and pain, domestic life and community, social and civic life [9]. Limitations in activities (i.e., “the execution of a task or action”) and restrictions in participation (i.e., “the involvement in a life situation”) are the most relevant problems for the affected individuals [9,10,11,12,13]. Interviews with affected individuals in geriatric care revealed that immobility does not necessarily lead to restrictions in participation, rather the restrictions are induced by environmental and personal factors [9]
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