SELF计划 "对护士活动鼓励行为和养老院居民ADL自立能力的影响；分组随机试验

IF 7.5 1区医学 Q1 NURSING

International Journal of Nursing Studies Pub Date : 2024-09-17 DOI:10.1016/j.ijnurstu.2024.104914

Stan Vluggen , Janneke de Man-van Ginkel , Gerard van Breukelen , Michel Bleijlevens , Sandra Zwakhalen , Getty Huisman-de Waal , Silke Metzelthin

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引用次数: 0

摘要

背景护士在鼓励疗养院居民活动和独立生活方面发挥着至关重要的作用。然而，护士经常不必要地接管任务，这可能会剥夺住户的剩余能力。注重功能的护理理念为制定支持护士优化老年人活动和独立性的计划提供了指导。然而，国际上开发的此类计划效果并不一致。为了改进未来的计划，我们总结了一些经验，从而开发出了 "SELF-计划"：一个以理论为基础的整体互动计划，旨在改善护士的活动鼓励行为，并间接优化疗养院居民的自立能力。本研究旨在考察 SELF 计划对护士的活动鼓励行为和疗养院居民在日常生活活动中的自立能力的影响。病房作为干预单位进行招募。MAINtAIN 问卷用于评估主要结果：护士在日常生活自理能力方面的活动鼓励行为。GARS-4 问卷用于评估次要结果：住院患者在日常生活活动中的自立能力。测量时间为1）基线，2）基线后三个月，3）基线后六个月（居民）和九个月（护士）。获得的数据采用混合线性回归法进行分析。结果有 287 名护士和 241 名居民参加了这项研究。在三个月（d = 0.53；p = .003；95 % CI 1.88-8.02）和九个月（d = 0.38；p = .02；95 % CI 0.67-7.27）时，护士的活动鼓励行为出现了统计学意义上的治疗与时间交互效应。在居民日常生活自理能力方面，没有观察到有统计学意义的治疗与时间的交互效应。然而，在那些被分配到有护士参与SELF项目的病房的住院者中，却观察到了自立能力下降不明显的趋势，这反映在三个月（d = - 0.25; p = 0.07; 95 % CI -2.21 - 0.09）和六个月（d = - 0.29; p = 0.07; 95 % CI -3.22 - 0.11）的小到中等的负效应大小上。与试验同时进行的过程评估可为在广泛实施 SELF 计划之前进一步改进该计划提供宝贵经验。招募工作于 2021 年 3 月开始。

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Effectiveness of the ‘SELF-program’ on nurses' activity encouragement behavior and nursing home resident's ADL self-reliance; a cluster-randomized trial

Background

Nurses play a crucial role in encouraging nursing home resident's activity and independent functioning. However, nurses often take over tasks unnecessarily, which can deprive resident's remaining abilities. The Function-Focused Care philosophy offers guidance for developing programs that support nurses to optimize activity and independence of older people. However, such programs developed internationally have demonstrated inconsistent effects. Lessons have been gathered to improve future programs, which led to the development of the ‘SELF-program’: a holistic, interactive and theory-based program that aims to improve activity encouragement behavior of nurses and indirectly to optimize self-reliance of nursing home residents.

Objective

The aim of this study was to examine the effectiveness of the SELF-program on nurses' activity encouragement behavior and nursing home residents' self-reliance in activities of daily living.

Method

The program's effectiveness was examined in a two-arm (SELF-program vs Care as Usual) cluster-randomized trial in Dutch nursing homes. Wards were recruited as units of intervention. The MAINtAIN questionnaire was used to assess the primary outcome: nurses' activity encouragement behavior regarding self-reliance in activities of daily living. The GARS-4 questionnaire was used to assess the secondary outcome: residents' self-reliance in activities of daily living. Measurements were taken at: 1) baseline, 2) three months after baseline, and 3) six months (for residents) and nine months (for nurses) after baseline. The acquired data was analyzed using mixed linear regression. Both adjusted and unadjusted analyses are reported.

Results

Twenty-eight nursing home wards, with 287 nurses and 241 residents participated in the study. A statistically significant treatment by time interaction effect was observed in nurses' activity encouragement behavior at three months (d = 0.53; p = .003; 95 % CI 1.88–8.02) and at nine months (d = 0.38; p = .02; 95 % CI 0.67–7.27). No statistically significant treatment by time interaction effects were observed in residents' self-reliance in activities of daily living. However, a trend was observed towards a less pronounced decrease in self-reliance in those residents allocated to wards that exposed nurses to the SELF-program, reflected by small to medium negative effect sizes at three months (d = − 0.25; p = .07; 95 % CI -2.21 – 0.09) and at six months (d = − 0.29; p = .07; 95 % CI -3.22 – 0.11).

Conclusion

The SELF-program was effective in improving nurses' activity encouragement behavior. The process evaluation conducted parallel to the trial could yield valuable lessons to further improve the SELF-program before widespread implementation.

Trial-registration

The study is registered in the Dutch Trial Register (NL9189), as of December 22 2020. Recruitment commenced in March 2021.

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来源期刊

International Journal of Nursing Studies 医学-护理

CiteScore

15.00

自引率

2.50%

发文量

181

审稿时长

21 days

期刊介绍： The International Journal of Nursing Studies (IJNS) is a highly respected journal that has been publishing original peer-reviewed articles since 1963. It provides a forum for original research and scholarship about health care delivery, organisation, management, workforce, policy, and research methods relevant to nursing, midwifery, and other health related professions. The journal aims to support evidence informed policy and practice by publishing research, systematic and other scholarly reviews, critical discussion, and commentary of the highest standard. The IJNS is indexed in major databases including PubMed, Medline, Thomson Reuters - Science Citation Index, Scopus, Thomson Reuters - Social Science Citation Index, CINAHL, and the BNI (British Nursing Index).