A mixed method study of an education intervention to reduce use of restraint and implement person-centered dementia care in nursing homes

Frode F Jacobsen, Tone Elin Mekki, Oddvar Førland, Bjarte Folkestad, Øyvind Kirkevold, Randi Skår, Eva Marie Tveit, Christine Øye, Frode F Jacobsen, Tone Elin Mekki, Oddvar Førland, Bjarte Folkestad, Øyvind Kirkevold, Randi Skår, Eva Marie Tveit, Christine Øye

Abstract

Background: People living with dementia in nursing homes are most likely to be restrained. The primary aim of this mixed-method education intervention study was to investigate which factors hindered or facilitated staff awareness related to confidence building initiatives based on person-centred care, as an alternative to restraint in residents with dementia in nursing homes. The education intervention, consisting of a two-day seminar and monthly coaching sessions for six months, targeted nursing staff in 24 nursing homes in Western Norway. The present article reports on staff-related data from the study.

Methods: We employed a mixed-method design combining quantitative and qualitative methods. The P-CAT (Person-centred Care Assessment Tool) and QPS-Nordic (The General Nordic questionnaire for psychological and social factors at work) instruments were used to measure staff effects in terms of person-centred care and perception of leadership. The qualitative data were collected through ethnographic fieldwork, qualitative interviews and analysis of 84 reflection notes from eight persons in the four teams who facilitated the intervention. The PARIHS (Promoting Action on Research Implementation in Health Services) theoretical framework informed the study design and the data analysis. Six nursing homes were selected for ethnographic study post-intervention.

Results: Qualitative data indicated increased staff awareness related to using restraint - or not- in the context of person-centered care. A slight increase in P-CAT supported these findings. Thirteen percent of the P-CAT variation was explained by institutional belonging. Qualitative data indicated that whether shared decisions of alternative measures to restraint were applied was a function of dynamic interplay between facilitation and contextual elements. In this connection, the role of the nursing home leaders appeared to be a pivotal element promoting or hindering person-centered care. However, leadership-staff relations varied substantially across individual institutions, as did staff awareness related to restraint and person-centeredness.

Conclusions: Leadership, in interplay with staff culture, turned out to be the most important factor hindering or promoting staff awareness related to confidence building initiatives, based on person-centered care. While quantitative data indicated variations across institutions and the extent of this variation, qualitative data offered insight into the local processes involved. A mixed method approach enabled understanding of dynamic contextual relationships.

Trial registration: The trial is registered at Clinical Trials gov. reg. 2012/304 NCT01715506.

Keywords: Dementia care; Education intervention; Implementation research; Leadership; Mixed methods; Nursing home staff; Person-centred care; Restraint.

Conflict of interest statement

Ethics approval and consent to participate

The MEDCED study was approved by the Regional Committee for Medical and Health Research Ethics in Norway (approval number 2012/304/REK vest, approved 28.03.2012), and information about the study was given to all staff and resident participants including collection of informed consent forms. All nursing homes and informants are anonymized. Ethical approval for the study with the facilitators was obtained from the Norwegian Social Science Data Services (Approval number 27399/3/MAB, approved 15.07.2011).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

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Fig. 1
Adjusted predictions with 95% Cls

References

    1. Selbæk G, Kirkevold O, Engedal K. The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes. Int J Geriatr Psychiatry. 2007;22:843–849. doi: 10.1002/gps.1749.
    1. Engedal K. The Norwegian dementia plan 2015—‘making most of the good days’. Int J Geriatr Psychiatry. 2010;25:928–930. doi: 10.1002/gps.2601.
    1. Kirkevold Ø, Engedal K. A study into the use of restraint in nursing homes in Norway. Br J Nurs. 2004;13:902–905. doi: 10.12968/bjon.2004.13.15.15527.
    1. Gulpers M, Bleijlevens M, van Rossum E, Capezuti E, Hamers J. Belt restraint reduction in nursing homes: design of a quasi-experimental study. BMC Geriatr. 2010;10:11. doi: 10.1186/1471-2318-10-11.
    1. Bredthauer D, Becker C, Eichner B, Koczy P, Nikolaus T. Factors relating to the use of physical restraints in psychogeriatric care: a paradigm for elder abuse. Z Gerontol Geriatr. 2005;38:10–18. doi: 10.1007/s00391-005-0285-y.
    1. Norwegian Board of Health Supervision . Tvil om tvang. Oppsummering av landsomfattende tilsyn med bruk av tvungen helsehjelp til pasienter i sykehjem. Oslo: Norwegian Board of Health Supervision; 2013.
    1. Zwijsen SA, Depla MFIA, Niemeijer AR, Francke AL, Hertogh CMPM. The concept of restraint in nursing home practice: a mixed method study in nursing home for people with dementia. Int Psychogeriatr. 2011;23(5):826–834. doi: 10.1017/S1041610210002267.
    1. Heeren P, Van de Water G, De Paepe L, Boonen S, Vieugels A. Staffing levels and the use of physical restraints in nursing homes: a multicenter study. J Gerontol Nurs. 2014;40(12):48–54. doi: 10.3928/00989134-20140407-03.
    1. Niemeijer AR, Depla M, Fredriks B, Francke AL, Hertogh C. The use of surveillance technology in residential facilities for people with dementia or intellectual disabilities: a study among nurses and support staff. Contin Educ. 2014;114(12):28–37.
    1. Testad I., Mekki TE, Forland O, Oeye, C, Tveit EM, Jacobsen F & Kirkevold Ø. Modelling and evaluating eviDence based continuing education program in nursing home dementia care (MEDCED). Training of nursing home staff to reduce use of restraint in nursing home residents with dementia. A cluster randomized controlled trial, International journal of geriatric psychiatry. 2015; DOI: 10.1002/gps.4285
    1. Kirkevold K, Laake K, Engedal K. Use of constraints and surveillance in Norwegian wards for the elderly. Int J Geriatr Psychiatry. 2003;18:491–497. doi: 10.1002/gps.883.
    1. Moore K, Haralambous B. Barriers to reducing the use of restraints in residential elder care facilities. J Adv Nurs. 2007;58(6):532–540. doi: 10.1111/j.1365-2648.2007.04298.x.
    1. Lovdata. The Chapter 4A in the revised Patients’ Rights Law of 1999. 2013. see: . Accessed 7 Sept 2017.
    1. Ageing & Health (Aldring & Helse). Demensomsorgens ABC. 2014. Link: . Accessed 7 Sept 2017.
    1. Creswell JW. A concise introduction to mixed methods research. USA: Sage Publications; 2015.
    1. Mekki TE, Øye C, Kristensen BM, Dahl H, Haaland A, Nordin KA, Strandos MR, Terum TM, Ydstebø AE & McCormack, B. T. Journal of Advanced Nursing. 2017. DOI: 10.1111/jan.13340.
    1. Testad I, Ballard C, Bronnick K, Aarsland D. The effect of staff training on agitation and use of restraint in nursing home residents with dementia: a single-blind, randomized controlled trial. J Clin Psychiatry. 2010;71:80–86. doi: 10.4088/JCP.09m05486oli.
    1. McCormack B, Dewing J & McCance T. Developing person-centred care: addressing contextual challenges through practice development. The Online Journal of Issues in Nursing. 2011;16. doi:10.3912/OJIN.Vol16No02Man03.
    1. Mekki TE. How do characteristics of context influence the work of facilitators when implementing a standardized education intervention targeting Nursing Home staff to reduce use of restraint in dementia care?. PhD Nursing Science, Queen Margaret University. 2015. Open access/Ethesis: . Accessed 7 Sept 2017.
    1. Kitson A, Rycroft-Malone J, Harvey G, McCormack B, Seers K, Titchen A. Evaluating the successful implementation of evidence into practice using the PARiSH framework: theoretical and practical challenges. Implementation Science. 2008;3(1), doi:10.1186/1748–5908–3-1.
    1. Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci. 2015;10(1):1. doi: 10.1186/s13012-015-0242-0.
    1. Eraut M. Developing a broader approach to professional learning. In: Mc Kee A, Eraut M, editors. Learning trajectories, innovation and identity for professional development. Netherland: Dodrecht: Springer; 2012. pp. 21–45.
    1. Billett S. Learning through work: workplace participatory practices. In: Rainbird H, Fuller A, Munro A, editors. Workplace learning in context. London and New York: Routledge; 2004. pp. 109–125.
    1. Hager P, Hodkinson P. Moving beyond the metaphor of transfer of learning. Br Educ Res J. 2009;35:619–638. doi: 10.1080/01411920802642371.
    1. Schnelle JF, et al. Translating clinical research into practice: a randomized controlled trial of exercise and incontinence care with nursing home patients. J Am Geriatr Soc. 2002;50(9):1476–1483. doi: 10.1046/j.1532-5415.2002.50401.x.
    1. Edvardsson D, Sandman PO, Nay R, Karlsson S. Associations between the working characteristics of nursing staff and the prevalence of behavioral symptoms in people with dementia in residential care. Int Psychogeriatr. 2008;20:764–776. doi: 10.1017/S1041610208006716.
    1. Edvardsson D, Sandman PO, Borell L. Improving staff wellbeing by implementing national guidelines for person-centred care of people with dementia: the Stureby intervention study. The Gerontologist. 2014;54(Suppl2):129.
    1. Willemse BM, de Jonge J, Smit D, Visser Q, Depla MF, Pot AM. Staff's Person-centredness in dementia care in relation to job characteristics and job-related well-being: a cross-sectional survey in nursing homes. J Adv Nurs. 2015;71(2):404–416. doi: 10.1111/jan.12505.
    1. Edvardsson D, et al. Development and initial testing of the personcentred care assessment tool (P-CAT) Int Psychogeriatr. 2010;22:101–108. doi: 10.1017/S1041610209990688.
    1. Dallner M, Elo AL, Gamberale F, Hottinen V, Knardahl S, Lindström K, Skogstad A & Ørhede E. Validation of the General Nordic Questionnaire (QPS-Nordic) for Psychological and Social Factors at Work. Nordic Council of Ministers, Copenhagen. Nord. 2000;12.
    1. McCormack B, Manley K, Titchen A. Practice development in nursing and healthcare. Wiley- Blackwell: Chichester; 2013.
    1. Øye S, Mekki, Tone E, Skår R, Dahl H, Førland O & Jacobsen FF. Evidence Molded by Contact with Staff Culture and Patient Milieu: an Analysis of the Social Process of Knowledge Utilization in Nursing Homes. Vocation and Learning. 2015; DOI: 10.1007/s12186-015-9135-2.
    1. Falzon MA. Introduction: Multi-sited ethnography: Theory, praxis and locality in contemporary research. In Multi-sited ethnography: Theory, praxis and locality in contemporary research, (M-A Falzon ed), Ashgate, Farnham. 2009:1–23.
    1. Lofland JD, Lofland LH. Analyzing social settings—a guide to qualitative observation and analysis. Belmont, California: Thomson Wadsworth; 2006.
    1. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277–1288. doi: 10.1177/1049732305276687.
    1. Øye, C., Mekki, TE, Jacobsen, FF, & Førland, O. Facilitating change from a distance - as story of success? A discussion on leaders’ styles in facilitating change in four nursing homes in Norway, Journal of nursing management; 2016. DOI: 10.1111/jonm.12378.
    1. Möhler R, Richter T, Köpke S, Meyer G. Interventions for preventing and reducing the use of physical restraints in long-term geriatric care (review) Cochrane Libr. 2011;4:1–32.
    1. Marchal B, Westhorp G, Wong G, Van Belle S, Greenhalgh T, Kegels G, Pawson R. Realist RCTs of complex interventions – an oxymoron. Soc Sci Med. 2013;94:124–128. doi: 10.1016/j.socscimed.2013.06.025.
    1. Resnick B, et al. Testing the feasibility of implementation of clinical practice guidelines in nursing homes. JAMDA. 2004;5:1–8.
    1. Gibb H. An environmental scan of an aged care workplace using the PARIHS model: assessing preparedness for change. J Nurs Manag. 2013;21:293–303. doi: 10.1111/j.1365-2834.2012.01407.x.
    1. Boström AM, Slaughter SE, Chojeckti D, Estabrooks CA. What do we know about knowledge translation in the care of older adults? A scoping review. JAMDA. 2012;13:210–219.

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