The complexity in the implementation process of empowerment-based chronic kidney care: a case study

BMC Nursing

Gerd Ahlström⁴  Kerstin Wikby³  Dan Malm²  Annette Nygårdh¹ 

[1] School of Health Sciences, Jönköping University, P.O. Box 1026, Jönköping SE-551 11, Sweden;Department of Internal Medicine, County Hospital Ryhov, Jönköping SE-55185, Sweden;Linneus University, Växjö SE- 351 95, Sweden;Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 187, Lund SE-221 00, Sweden

关键词: Quality of care;    Qualitative research;    Interactive research;    Individualized care;    Improvement intervention;    Implementation process;    Healthcare professionals;    Empowerment;    Case study;   

Others  :  1091028
DOI  :  10.1186/1472-6955-13-22

 received in 2013-05-09, accepted in 2014-07-23,  发布年份 2014

【 摘 要 】

Background

This study is part of an interactive improvement intervention aimed to facilitate empowerment-based chronic kidney care using data from persons with CKD and their family members. There are many challenges to implementing empowerment-based care, and it is therefore necessary to study the implementation process. The aim of this study was to generate knowledge regarding the implementation process of an improvement intervention of empowerment for those who require chronic kidney care.

Methods

A prospective single qualitative case study was chosen to follow the process of the implementation over a two year period. Twelve health care professionals were selected based on their various role(s) in the implementation of the improvement intervention. Data collection comprised of digitally recorded project group meetings, field notes of the meetings, and individual interviews before and after the improvement project. These multiple data were analyzed using qualitative latent content analysis.

Results

Two facilitator themes emerged: Moving spirit and Encouragement. The healthcare professionals described a willingness to individualize care and to increase their professional development in the field of chronic kidney care. The implementation process was strongly reinforced by both the researchers working interactively with the staff, and the project group. One theme emerged as a barrier: the Limitations of the organization. Changes in the organization hindered the implementation of the intervention throughout the study period, and the lack of interplay in the organization most impeded the process.

Conclusions

The findings indicated the complexity of maintaining a sustainable and lasting implementation over a period of two years. Implementing empowerment-based care was found to be facilitated by the cooperation between all involved healthcare professionals. Furthermore, long-term improvement interventions need strong encouragement from all levels of the organization to maintain engagement, even when it is initiated by the health care professionals themselves.

【 授权许可】

   
2014 Nygårdh et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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