Feasibility, acceptability, and adherence of two educational programs for care staff concerning nursing home patients' fecal incontinence: a pilot study preceding a cluster-randomized controlled trial.
Feasibility, acceptability, and adherence of two educational programs for care staff concerning nursing home patients' fecal incontinence: a pilot study preceding a cluster-randomized controlled trial.
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DOI：
10.1186/s13012-015-0263-8
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发表时间：
2015-05-23
期刊：
影响因子：
--
通讯作者：
Vinsnes AG
中科院分区：
文献类型：
--
作者：
Blekken LE;Nakrem S;Gjeilo KH;Norton C;Mørkved S;Vinsnes AG
在养老院人群中，大便失禁的患病率较高，这不能仅用共病或衰老的解剖学和生理学变化来解释。我们的假设是，通过向护理人员提供最佳实践知识，大便失禁可以得到预防、治愈或改善。然而，尚不清楚哪种教育模式最有效。为了评估针对护理人员的两种教育方案的效果，我们策划了一项三组集群随机对照试验。缺乏针对老年患者改善失禁护理流程的干预措施效果的研究报告。因此，为了提高计划试验的质量，我们决定进行一项试点研究，以调查计划设计、干预措施（教育方案）和结果测量的可行性，并进行功效计算。本文报告了试点研究的结果。
招募了代表计划试验每组的三家养老院。预先确定了评估可行性成功的标准。通过描述性统计分析以及对一个焦点小组访谈（n = 7）和四次个人访谈的定性内容分析，对干预措施各组成部分的方法、结果测量、可接受性和依从性进行了评估。
主要研究在进行一项重大修改和一些小修改后是可行的。由于招募方面的挑战以及有迹象支持仅一次研讨会的单一干预作为实施策略是不够的这一假设，主要研究将减少为两组：多层面教育干预组和对照组。多层面干预的各个组成部分似乎配合良好，只需进行小的修改。需要考虑的重要障碍包括技能组合使用不理想、重要评估和护理计划沟通存在问题以及护士身份不明确的孤立护士。
总体而言，主要研究是可行的。教学方法需要考虑已确定的障碍。因此，至关重要的是要赋予护士其职业角色的权力，促进护理人员的临床推理和批判性思维，并促进相关流程，使护理人员能够查找、报告和利用电子病历中的信息。
临床试验注册号：NCT01939821
Fecal incontinence has a high prevalence in the nursing home population which cannot be explained by co-morbidity or anatomic and physiological changes of aging alone. Our hypothesis is that fecal incontinence can be prevented, cured, or ameliorated by offering care staff knowledge of best practice. However, it is not clear which educational model is most effective. To assess the effect of two educational programs for care staff, we planned a three armed cluster-randomized controlled trial. There is a lack of research reporting effects of interventions targeting improved continence care processes in older patients. Thus, to improve the quality of the planned trial, we decided to carry out a pilot study to investigate the feasibility of the planned design, the interventions (educational programs) and the outcome measures, and to enable a power calculation. This paper reports the results from the pilot study. Three nursing homes, representing each arm of the planned trial, were recruited. Criteria for assessing success of feasibility were pre-specified. Methods, outcome measures, acceptability, and adherence of the components of the intervention were evaluated by descriptive statistical analyses and qualitative content analysis of one focus group interview (n = 7) and four individual interviews. The main study is feasible with one major and some minor modifications. Due to challenges with recruitment and indications supporting the assumption that a single intervention with one workshop is not sufficient as an implementation strategy, the main study will be reduced to two arms: a multifaceted education intervention and control. The components of the multifaceted intervention seemed to work well together and need only minor modification. Important barriers to consider were sub-optimal use of skill-mix, problems of communicating important assessments and care plans, and isolated nurses with an indistinct nurse identity. Overall, the main study is feasible. The pedagogical approach needs to consider the identified barriers. Thus, it is essential to empower nurses in their professional role, to facilitate clinical reasoning and critical thinking among care staff, and to facilitate processes to enable care staff to find, report, and utilize information in the electronic patient record. ClinicalTrials.gov: NCT01939821
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
6.6
作者：
Sederer, Lloyd I.
通讯作者：
Sederer, Lloyd I.
影响因子：
15.8
作者：
Schulz KF;Altman DG;Moher D;CONSORT Group
通讯作者：
CONSORT Group
影响因子：
1.9
作者：
LANDIS, JR;KOCH, GG
通讯作者：
KOCH, GG
影响因子：
3.3
作者：
Haddock, Gillian;Eisner, Emily;Barrowclough, Christine
通讯作者：
Barrowclough, Christine