‘Stand still …, and move on’ , an early neurologically-focused follow-up for cardiac arrest survivors and their caregivers: a process evaluation

BMC Health Services Research

Jeanine A Verbunt⁴  Caroline M van Heugten¹  Derick T Wade²  Jolanda CM van Haastregt³  Véronique RM Moulaert⁴ 

[1]Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, the Netherlands

[2]Oxford Centre for Enablement, Nuffield Orthopaedic Centre, Oxford, UK

[3]Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre+, Maastricht, the Netherlands

[4]Department of Rehabilitation Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre+, Maastricht, the Netherlands

关键词: Process evaluation;    Feasibility;    Nursing intervention;    Caregiver;    Emotional impairments;    Cognitive impairments;    Hypoxic-ischaemic brain injury;    Cardiac arrest;   

Others  :  1134265
DOI  :  10.1186/1472-6963-14-34

 received in 2012-12-19, accepted in 2014-01-07,  发布年份 2014

【 摘 要 】

Background

A cardiac arrest can lead to hypoxic-ischaemic brain injury which can result in cognitive and emotional impairments and may negatively affect daily functioning, participation in society and quality of life. Furthermore, the impact on the family of the patient can be high. We designed an intervention called ‘Stand still …, and move on’, which is a concise, individualised, semi-structured intervention for survivors of cardiac arrest and their caregivers, consisting of between one and six face-to-face consultations provided by a trained nurse. The intervention is directed at early detection of cognitive and emotional problems, provision of information, promotion of self-management and referral to specialised care if necessary. The effectiveness of the intervention is being examined in a randomised controlled trial [ISRCTN74835019]. Alongside this trial we performed a process evaluation which aims to investigate the feasibility of the intervention by assessing: 1) the attendance and dose delivered; 2) performance according to protocol; and 3) the opinion of patients, caregivers and nurses on the intervention.

Methods

Participants of this process evaluation were 97 patients allocated to the intervention group of the RCT, their 91 caregivers, and six nurses who conducted the intervention. Measurement instruments used were evaluation forms for patients and caregivers, registration and evaluation forms for nurses, and semi-structured interviews with nurses.

Results

Seventy-nine of the patients (81%) allocated to the intervention group and 65 caregivers (71%) participated in the intervention. The mean (SD) number of consultations per patient was 1.8 (1.0), and most consultations were conducted at the patients’ home. The intervention was performed largely according to protocol, except that the intervention usually started later than intended, consultations were longer than expected, and the topic of self-management was not regularly addressed. Patients marked the quality of the intervention with a mean score of 7.5 and the performance of the nurse with an 8.0 out of ten. Overall, the intervention was positively evaluated by patients, caregivers and nurses.

Conclusions

The intervention ‘Stand still …, and move on’ is a promising intervention which was performed largely according to protocol and seems feasible for implementation after some adaptations, if it is found to be effective.

【 授权许可】

   
2014 Moulaert et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Busl KM, Greer DM: Hypoxic-ischemic brain injury: pathophysiology, neuropathology and mechanisms. NeuroRehabilitation 2010, 26(1):5-13.
• [2]de Vos R, de Haes HC, Koster RW, de Haan RJ: Quality of survival after cardiopulmonary resuscitation. Arch Intern Med 1999, 159(3):249-254.
• [3]Lundgren-Nilsson A, Rosen H, Hofgren C, Sunnerhagen KS: The first year after successful cardiac resuscitation: function, activity, participation and quality of life. Resuscitation 2005, 66(3):285-289.
• [4]Wachelder EM, Moulaert VR, van Heugten C, Verbunt JA, Bekkers SC, Wade DT: Life after survival: long-term daily functioning and quality of life after an out-of-hospital cardiac arrest. Resuscitation 2009, 80(5):517-522.
• [5]Moulaert VR, Verbunt JA, Bakx WG, Gorgels AP, de Krom MC, Heuts PH, Wade DT, Van Heugten CM: ‘Stand still …, and move on’ , a new early intervention service for cardiac arrest survivors and their caregivers: rationale and description of the intervention. Clin Rehabil 2011, 25(10):867-879.
• [6]Cowan MJ, Pike KC, Budzynski HK: Psychosocial nursing therapy following sudden cardiac arrest: impact on two-year survival. Nurs Res 2001, 50(2):68-76.
• [7]Dougherty CM, Thompson EA, Lewis FM: Long-term outcomes of a telephone intervention after an ICD. Pacing Clin Electrophysiol 2005, 28(11):1157-1167.
• [8]Moulaert VR, Verbunt JA, van Heugten CM, Wade DT: Cognitive impairments in survivors of out-of-hospital cardiac arrest: a systematic review. Resuscitation 2009, 80(3):297-305.
• [9]Moulaert VR, Wachelder EM, Verbunt JA, Wade DT, van Heugten CM: Determinants of quality of life in survivors of cardiac arrest. J Rehabil Med 2010, 42(6):553-558.
• [10]Moulaert VR, Verbunt JA, van Heugten CM, Bakx WG, Gorgels AP, Bekkers SC, de Krom MC, Wade DT: Activity and Life After Survival of a Cardiac Arrest (ALASCA) and the effectiveness of an early intervention service: design of a randomised controlled trial. BMC Cardiovasc Disord 2007, 7(1):26. BioMed Central Full Text
• [11]Saunders RP, Evans MH, Joshi P: Developing a process-evaluation plan for assessing health promotion program implementation: a how-to guide. Health Promot Pract 2005, 6(2):134-147.
• [12]Oakley A, Strange V, Bonell C, Allen E, Stephenson J: Process evaluation in randomised controlled trials of complex interventions. BMJ 2006, 332(7538):413-416.
• [13]van Heugten C, Rasquin S, Winkens I, Beusmans G, Verhey F: Checklist for cognitive and emotional consequences following stroke (CLCE-24): development, usability and quality of the self-report version. Clin Neurol Neurosurg 2007, 109(3):257-262.
• [14]Alderson AL, Novack TA: Reliable serial measurement of cognitive processes in rehabilitation: the Cognitive Log. Arch Phys Med Rehabil 2003, 84(5):668-672.
• [15]Spinhoven P, Ormel J, Sloekers PP, Kempen GI, Speckens AE, Van Hemert AM: A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med 1997, 27(2):363-370.
• [16]Sundin EC, Horowitz MJ: Impact of event scale: psychometric properties. Br J Psychiatry 2002, 180:205-209.
• [17]Thornton M, Travis SS: Analysis of the reliability of the modified caregiver strain index. J Gerontol B Psychol Sci Soc Sci 2003, 58(2):S127-S132.
• [18]Bodenheimer T, Lorig K, Holman H, Grumbach K: Patient self-management of chronic disease in primary care. JAMA 2002, 288(19):2469-2475.
• [19]Lorig KR, Holman H: Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med 2003, 26(1):1-7.
• [20]Jovicic A, Holroyd-Leduc JM, Straus SE: Effects of self-management intervention on health outcomes of patients with heart failure: a systematic review of randomized controlled trials. BMC Cardiovasc Disord 2006, 6:43. BioMed Central Full Text
• [21]Edwards DF, Hahn MG, Baum CM, Perlmutter MS, Sheedy C, Dromerick AW: Screening patients with stroke for rehabilitation needs: validation of the post-stroke rehabilitation guidelines. Neurorehabil Neural Repair 2006, 20(1):42-48.