Function focused care in hospital among nurses and patients from geriatric and neurology wards: A mixed method process evaluation

Abstract

Background

Function Focused Care is a promising approach stimulating physical activity of patients admitted to hospital. In studying the effectiveness, patients receiving Function Focused Care in Hospital were admitted 3.3 days shorter than patients receiving usual care. However, no differences were found in functional status. Process evaluations alongside an effect studies create an understanding implementation fidelity, of mechanisms of impact, contextual factors.

Objective

to gain insight into the experiences of nurses and patients, and to give insight into implementation fidelity, mechanisms of impact, and contextual factors while implementing Function Focused Care in Hospital on geriatric and neurologic hospital wards.

Design

convergent parallel mixed-methods study, alongside a stepped wedge clinical trial.

Setting(s)

four hospital wards of two Dutch hospitals

Participants

nurses, nursing students and care assistants (n = 123), and patients (n = 24).

Methods

Data for the process evaluation was collected before the implementation of Function Focused Care in Hospital (T0), directly after implementation (T1), and four months after implementation (T2). Data was obtained from patient interviews, focus group interviews with nurses, questionnaires, observations, screening of electronic patients’ records, and logbook notes. For the qualitative data thematic analyses and for quantitative data descriptive statistics were used. The results of these analyses were synthesized into overarching findings.

Results

Findings from the observations showed the care delivery according to the Function Focused Care in Hospital principles increased from 60 % in the control condition to 75 % in the intervention condition. Moreover, nurses stated that patients were only assisted when needed and nurses often asked about their abilities to perform ADL and then encouraged them to do as much as they could themselves. Nevertheless, patients don’t recognize Function Focused Care in Hospital. The results suggest that the implementation fidelity was influenced by different working mechanisms and contextual factors which led to different experiences from nurses, coaches and patients in promoting patient engagement and functional independence. The synthesized findings show that lessons can be learned with regards to continuity of the care provided in the interprofessional collaboration, the challenge in providing personalized care given the current time constraints, the phenomenon of being unconscious incompetent observed in the nurses, and difficulties in demonstrating nursing leadership and autonomy.

Conclusions

Implementation of Function Focused Care in Hospital improved care delivery but highlighted challenges in personalized care, interprofessional collaboration, and nursing leadership, influenced by various contextual factors and working mechanisms.

Registration

https://onderzoekmetmensen.nl/en/trial/24287 (date of first recruitment: 05–02–2016)