Strengthening the role and functions of nursing staff in inpatient stroke rehabilitation: developing a complex intervention using the Behaviour Change Wheel

Abstract

Purpose: Over the past two decades, attempts have been made to describe the nurse's role and functions in the inpatient stroke rehabilitation; however, the nursing contribution is neither clear nor well-defined. Previous studies have highlighted the need for research aimed at developing interventions in the neuro-nursing area. The objective of this paper was to describe the development of a nursing intervention aimed at optimising the inpatient rehabilitation of stroke patients by strengthening the role and functions of nursing staff. Method: A systematic approach was used, consistent with the framework for developing and evaluating complex interventions by the UK's Medical Research Council (MRC). Based on qualitative methods and using the Behaviour Change Wheel's (BCW) stepwise approach, we sought behaviours related to nursing staffs' roles and functions. Results: We conducted a behavioural analysis to explain why nursing staff were or were not engaged in these behaviours. The nursing staff's Capability, Opportunity and Motivation were analysed with regard to working systematically with a rehabilitative approach and working deliberately and systematically with the patient's goals. Conclusion: We developed the educational intervention Rehabilitation 24/7. Following the MRC and the BCW frameworks is resource-consuming, but offers a way of developing a practical, well-structured intervention that is theory-and evidence based. ARTICLE HISTORY

Nursing staffs self-perceived outcome from a rehabilitation 24/7 educational programme – a mixed-methods study in stroke care

“…The educational programme named “Rehabilitation 24/7” was designed to strengthen the nursing staff’s rehabilitative practices. The intervention addressed key barriers identified within the COM-B model with the purpose of achieving behavioural change in the nursing staff [ 16 ]. The specific goals of the intervention for the nursing staff were as follows: To work systematically with a rehabilitative approach in all aspects of patient care To work deliberately and systematically with patients’ goals.…”

“…Moreover, they had insider perspectives as a former patient and as a relative, respectively. The intervention was developed based on existing relevant research and empirical research undertaken by the developers of the intervention (interviews and field observations in the chosen stroke unit) [ 16 , 19 , 20 ]. In the early development stages, field observations were also conducted in another rehabilitation inpatient setting to broaden perspectives and later to validate the findings.…”

“…An intervention for stroke rehabilitation that could strengthen the nursing staff’s contributions is a complex intervention that largely centres on behavioural change. We therefore chose to develop an evidence- and theory-based intervention guided by the British Medical Research Council’s (MRC) framework for complex interventions [ 15 ] to ensure a systematic and evidence based development and Michie’s Behaviour Change Wheel (BCW) [ 14 ] as the intervention would address behaviour change [ 16 ]. Furthermore, we addressed implementation from the outset by developing a strategy following the steps recommended by Grol and Wensing [ 13 ].…”

Examining subacute nurses’ roles in a changing healthcare context

“…Nurses are often expected to substitute for absent allied health staff, which requires them to have a broad knowledge of the roles of others and adds to the vagueness of the definition of nursing in this context (Aadal et al, 2013). Nurses have adapted to changing expectations, with the role evolving to include a more diverse range of duties because of these changes (Dreyer et al, 2016; Loft, Martinsen, et al, 2017). However, understanding of the specific contribution nurses make to rehabilitation remains limited (Clarke, 2014; Loft, Poulsen, et al, 2017).…”

Strengthening nursing role and functions in stroke rehabilitation 24/7: A mixed‐methods study assessing the feasibility and acceptability of an educational intervention programme

“…An evidence‐ and theory‐based educational intervention (Loft, Martinsen Woythal, et al, 2017; Loft, Martinsen, et al, 2017) was systematically developed using these approaches that address the nursing staff’s capability (C), opportunity (O) and motivation (M) (COM‐B; Michie et al, 2014). …”