Feasibility, acceptability, and adherence of two educational programs for care staff concerning nursing home patients’ fecal incontinence: a pilot study preceding a cluster-randomized controlled trial

Implementation Science

Anne Guttormsen Vinsnes¹  Siv Mørkved³  Christine Norton⁴  Kari Hanne Gjeilo²  Sigrid Nakrem¹  Lene Elisabeth Blekken¹ 

[1] Faculty of Nursing, Sør-Trøndelag University College, Trondheim, Norway;Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway;Clinical Service, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway;Faculty of Nursing and Midwifery, King’s College London, 57 Waterloo Road, London SE1 8WA, UK

关键词: Nursing;    Care processes;    Feasibility study;    Pilot study;    Implementation study;    Older patients;    Long-term care;    Nursing homes;    Fecal incontinence;   

Others  :  1219034
DOI  :  10.1186/s13012-015-0263-8

 received in 2014-12-19, accepted in 2015-05-15,  发布年份 2015

【 摘 要 】

Background

Fecal incontinence has a high prevalence in the nursing home population which cannot be explained by co-morbidity or anatomic and physiological changes of aging alone. Our hypothesis is that fecal incontinence can be prevented, cured, or ameliorated by offering care staff knowledge of best practice. However, it is not clear which educational model is most effective. To assess the effect of two educational programs for care staff, we planned a three armed cluster-randomized controlled trial. There is a lack of research reporting effects of interventions targeting improved continence care processes in older patients. Thus, to improve the quality of the planned trial, we decided to carry out a pilot study to investigate the feasibility of the planned design, the interventions (educational programs) and the outcome measures, and to enable a power calculation. This paper reports the results from the pilot study.

Methods

Three nursing homes, representing each arm of the planned trial, were recruited. Criteria for assessing success of feasibility were pre-specified. Methods, outcome measures, acceptability, and adherence of the components of the intervention were evaluated by descriptive statistical analyses and qualitative content analysis of one focus group interview (n = 7) and four individual interviews.

Results

The main study is feasible with one major and some minor modifications. Due to challenges with recruitment and indications supporting the assumption that a single intervention with one workshop is not sufficient as an implementation strategy, the main study will be reduced to two arms: a multifaceted education intervention and control. The components of the multifaceted intervention seemed to work well together and need only minor modification. Important barriers to consider were sub-optimal use of skill-mix, problems of communicating important assessments and care plans, and isolated nurses with an indistinct nurse identity.

Conclusions

Overall, the main study is feasible. The pedagogical approach needs to consider the identified barriers. Thus, it is essential to empower nurses in their professional role, to facilitate clinical reasoning and critical thinking among care staff, and to facilitate processes to enable care staff to find, report, and utilize information in the electronic patient record.

Trial registration

ClinicalTrials.gov: NCT01939821 webcite

【 授权许可】

   
2015 Blekken et al.; licensee BioMed Central.

【 图 表 】

Fig. 1.

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