Evaluation of nurses’ changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care: a qualitative study

Abstract

ObjectivesTo gain insights into the process of nurses’ changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care, and into the factors that contributed to these changes in their perceptions.DesignQualitative study alongside a cluster randomised controlled trial.Setting17 long-term care homes spread across the Netherlands.Participants34 licensed practical nurses supporting 54 dual sensory impaired older adults.InterventionA 5-month training programme designed to enable nurses to support the self-management of dual sensory impaired older adults in long-term care.Primary outcomesNurses’ perceptions on relevance and feasibility of the self-management programme collected from nurses’ semistructured coaching diaries over the 5-month training and intervention period, as well as from trainers’ reports.ResultsNurses’ initial negative perceptions on relevance and feasibility of the intervention changed to positive as nurses better understood the concept of autonomy. Through interactions with older adults and by self-evaluations of the effect of their behaviour, nurses discovered that their usual care conflicted with client autonomy. From that moment, nurses felt encouraged to adapt their behaviour to the older adults’ autonomy needs. However, nurses’ initial unfamiliarity with conversation techniques required a longer exploration period than planned. Once client autonomy was understood, nurses recommended expanding the intervention as a generic approach to all their clients, whether dual sensory impaired or not.ConclusionsLongitudinal data collection enabled exploration of nurses’ changes in perceptions when moving towards self-management support. The training programme stimulated nurses to go beyond ‘protocol thinking’, discovering client autonomy and exploring the need for their own behavioural adaptations. Educational programmes for practical nurses should offer more longitudinal coaching of autonomy supportive conversational skills. Intervention programming should acknowledge that change is a process rather than an event, and should include self-evaluations of professional behaviours over a period of time.Trial registration numberNCT01217502, Post-results.

Exploring Professionals’ Experiences in the Rehabilitation of Older Clients with Dual-Sensory Impairment

“…In the case of older adults with DSI, one study has explored nurses' roles and perceptions of a selfmanagement rehabilitation strategy for older adults in long-term care with DSI (Roets-Merken et al, 2016).…”

“…In their longitudinal qualitative study, Roets-Merken et al (2016) found that nurses initially held negative perceptions about the benefits of a self-management program for individuals with DSI. Yet, after working with these individuals, the nurses had a more positive perspective on the benefits of the program, and they also gained insights concerning adaptations needed in their approach to better support this clientele.…”

Effectiveness of a nurse-supported self-management programme for dual sensory impaired older adults in long-term care: a cluster randomised controlled trial

“…At the start of the intervention period, we observed a similar lack of partnership between the DSI older adults and their nurse. 44 The feelings of partnership only developed after nurses and older adults started a dialogue based on the SMP-DSI steps.…”

“…However, nurses’ changing perceptions in the course of the intervention, starting from fairly negative to positive perceptions (as reported in our parallel study), might have negatively affected the results. 44 …”

“…Our findings on relevance and feasibility have been reported in a separate qualitative study. 44 In addition, we analysed the collection of problems addressed with the SMP-DSI in this cRCT; these were reported in a second separate qualitative study. 45 …”