A theory‐based hybrid <scp>II</scp> implementation intervention to improve pain management in Swiss nursing homes: A mixed‐methods study protocol

Brunkert, Thekla; Ruppen, Wilhelm; Simon, Michaël; Zúñiga, Franziska

doi:10.1111/jan.13817

Cited by 8 publications

(5 citation statements)

References 45 publications

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“…This proved the CFIR’s potential to study the process ( how ) and influencing factors ( which ) simultaneously. While some studies select one CFIR domain on the basis of theoretical considerations [ 44 – 46 ], this study, based on a qualitative analysis, provided insights into the CFIR constructs most relevant for our study. Powell et al [ 47 ] recommend systematically selecting and tailoring implementation strategies on empirical grounds.…”

Section: Discussionmentioning

confidence: 99%

Types of implementation of the dementia-specific case conference concept WELCOME-IdA in nursing homes: a qualitative process evaluation of the FallDem effectiveness trial

Teupen

Holle

Roes

2021

Implement Sci Commun

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Background Dementia is regularly associated with behavioral and psychological symptoms of dementia (BPSD, also referred to as challenging behavior). Structured dementia-specific case conferences (DSCCs) enable nursing staff in nursing homes (NHs) to analyze and handle the BPSD of residents with dementia. The FallDem trial estimated the effectiveness of the structured DSCC intervention WELCOME-IdA (Wittener model of case conferences for people with dementia – the Innovative dementia-oriented Assessment tool) in NHs in Germany. No significant change in the overall prevalence of challenging behavior was found. A multipart process evaluation was conducted to explain this result. Methods This qualitative process evaluation of the response of individuals, perceived maintenance, effectiveness, and unintended consequences was part of the multipart process evaluation that followed the framework by Grant et al. (Trials 14: 15, 2013). It used the data from semi-structured telephone interviews and focus group interviews with nurses and managers as secondary data. Selected domains of the Consolidated Framework for Implementation Research (CFIR) were used as deductive categories for a directed content analysis. Results The interviewees in all NHs appraised WELCOME-IdA as generating positive change, although it proved important that some adjustments were made to the intervention and the organization. Thirteen CFIR constructs out of the domains intervention characteristics, inner setting, and process proved to be essential for understanding the different course that the implementation of WELCOME-IdA took in each of the four NHs. This is reflected in three types of WELCOME-IdA implementation: (1) priority on adjusting the intervention to fit the organization, (2) priority on adjusting the organization to fit the intervention, and (3) no setting of priorities in adjusting either the organization or the intervention. Conclusion The unsatisfying results of the FallDem effectiveness trial can in part be explained with regard to the interplay between the intervention and the implementation which was revealed in the processes that occurred in the organizations during the implementation of the WELCOME-IdA intervention. Future implementation of WELCOME-IdA should be tailored based on an analysis of the organization’s readiness, resources, and capacities and should also define custom-made intervention and implementation outcomes to measure success. Furthermore, our results confirm that the CFIR can be used beneficially to conduct process evaluations.

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Section: Discussionmentioning

confidence: 99%

Types of implementation of the dementia-specific case conference concept WELCOME-IdA in nursing homes: a qualitative process evaluation of the FallDem effectiveness trial

Teupen

Holle

Roes

2021

Implement Sci Commun

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“…A protocol for this study describing the intervention and implementation strategies in more detail was published previously (Brunkert, Ruppen, Simon, & Zúñiga 2019). We developed a pain management guideline based on international recommendations for the management of geriatric pain, as Switzerland had no national guideline for the management of geriatric pain (American Geriatric Society Panel on Persistent Pain in Older Persons, 2009).…”

Section: Methodsmentioning

confidence: 99%

Use of Pain Management Champions to Enhance Guideline Implementation by Care Workers in Nursing Homes

Brunkert

Simon

Zúñiga

2021

Worldviews Ev Based Nurs

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Background Underutilization of evidence‐based pain management in nursing homes (NHs) is common. Evidence toward effective approaches to improve adoption of evidence‐based practices in NHs is limited. Application of theory in evaluation approaches can increase understanding of implementation challenges. Aim To get a better understanding of the impact of implementation strategies by exploring the underlying mechanisms using behavioral theory. Methods This mixed‐methods study is embedded in an implementation‐effectiveness study of a pain management guideline in four Swiss NHs. To evaluate our implementation strategies, training workshops were held, and trained pain champions were introduced. We also developed a conceptual framework. Based on Bandura’s self‐efficacy theory, we hypothesized how our implementation strategies might affect changes in care workers’ behavior. Care workers’ questionnaire surveys were conducted at baseline (n = 136), after 3 months (n = 99), and after 6 months (n = 83) to assess self‐efficacy in pain management and self‐reported guideline adoption. We computed linear mixed‐effect models to assess changes over time in self‐efficacy and logistic regressions to assess associations between self‐efficacy and guideline adoption. Concurrently, we conducted focus groups with care workers (n = 8) to explore their response to the implementation strategies. Results Overall, there was a significant increase in self‐efficacy at both time points (p < .001). We found significant associations between self‐efficacy and adoption of two guideline components, that is, performing a comprehensive pain assessment and using observational pain assessment tools in cognitively impaired residents. Qualitative findings showed that implementation strategies were received positively by care workers. Focus group participants reported more attentiveness to residents’ pain experience. The participants also reported increases in assessment and documentation of pain with more detail than before. Linking Evidence to Action Our findings highlighted that the training and use of pain champions increased self‐efficacy and thereby induced behavior change leading to guideline adoption. Regarding persistent implementation challenges, a theory‐based conceptual model contributes to the overall understanding.

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“…The intervention and implementation strategies were described in detail elsewhere . A facility pain management guideline was developed based on existing evidence‐based guidelines and involvement of local stakeholders .…”

Section: Methodsmentioning

confidence: 99%

“…A facility pain management guideline was developed based on existing evidence‐based guidelines and involvement of local stakeholders . The adapted guideline included these core elements targeted in this study: (1) comprehensive pain assessment of both new residents (on admission) experiencing pain and of any residents with new or deteriorating pain situations; (2) use of the Pain Assessment in Advanced Dementia (PAINAD) scale for the observational assessment of pain in residents with severe cognitive impairment; (3) routine pain assessment and reevaluation; and (4) standardized documentation after pharmacologic or nonpharmacologic measures . In addition to these core elements, the guideline comprised recommendations concerning the application of pharmacologic and nonpharmacologic approaches to pain management according to international guidelines…”

Section: Methodsmentioning

confidence: 99%

Pain Management in Nursing Home Residents: Findings from a Pilot Effectiveness‐Implementation Study

Brunkert

Simon

Ruppen

et al. 2019

J American Geriatrics Society

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OBJECTIVES To evaluate the effectiveness and implementation of a multilevel pain management intervention in nursing homes (NHs) comprising a pain management guideline, care worker training, and pain champions. DESIGN An implementation science pilot study using a quasi‐experimental effectiveness‐implementation (hybrid II) design. SETTING Four NHs in Switzerland. PARTICIPANTS All consenting long‐term residents aged 65 years and older with pain at baseline (N = 62) and all registered and licensed practical nurses (N = 61). INTERVENTION Implementation of a contextually adapted pain management guideline, interactive training workshops for all care workers, and specifically trained pain champions. MEASUREMENTS Interference from pain, worst and average pain intensity over the previous 24 hours; proxy ratings of pain with the Pain Assessment in Advanced Dementia scale; and care workers' appraisal of the guideline's reach, acceptability, and adoption. RESULTS Pain‐related outcomes improved for self‐reporting residents (n = 43) and residents with proxy rating (n = 19). Significant improvements of average pain from baseline to T1 (P = .006), and in worst pain from baseline to T1 (P = .003) and T2 (P = .004). No significant changes in interference from pain (P = .18). With regard to the implementation efforts, about 76% of care workers indicated they were familiar with the guideline; 70.4% agreed that the guideline is practical and matches their ideas of good pain assessment (75.9%) and treatment (79.7%). CONCLUSION Implementation of a multilevel pain management intervention did significantly improve average and worst pain intensity in NH residents. However, to effect clinical meaningful changes in interference from pain, a more comprehensive approach involving other disciplines may be necessary. J Am Geriatr Soc 67:2574–2580, 2019

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A theory‐based hybrid II implementation intervention to improve pain management in Swiss nursing homes: A mixed‐methods study protocol

Abstract: ClinicalTrials.gov: NCT03471390.

Cited by 8 publications

References 45 publications

Types of implementation of the dementia-specific case conference concept WELCOME-IdA in nursing homes: a qualitative process evaluation of the FallDem effectiveness trial

Types of implementation of the dementia-specific case conference concept WELCOME-IdA in nursing homes: a qualitative process evaluation of the FallDem effectiveness trial

Use of Pain Management Champions to Enhance Guideline Implementation by Care Workers in Nursing Homes

Pain Management in Nursing Home Residents: Findings from a Pilot Effectiveness‐Implementation Study

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