Implementation of a Stepwise, Multidisciplinary Intervention for Pain and Challenging Behaviour in Dementia (STA OP!): A Process Evaluation
Background: A stepwise, multidisciplinary and multicomponent intervention (called STA OP!) was implemented in Dutch nursing home units, which included a comprehensive multidisciplinary team training. A cluster-randomised controlled trial showed that the intervention reduced symptoms of pain and chal...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Ubiquity Press
2018-09-01
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| Series: | International Journal of Integrated Care |
| Subjects: | |
| Online Access: | https://www.ijic.org/articles/3973 |
| _version_ | 1818720598829826048 |
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| author | Marjoleine J.C. Pieper Wilco P. Achterberg Jenny T. van der Steen Anneke L. Francke |
| author_facet | Marjoleine J.C. Pieper Wilco P. Achterberg Jenny T. van der Steen Anneke L. Francke |
| author_sort | Marjoleine J.C. Pieper |
| collection | DOAJ |
| description | Background: A stepwise, multidisciplinary and multicomponent intervention (called STA OP!) was implemented in Dutch nursing home units, which included a comprehensive multidisciplinary team training. A cluster-randomised controlled trial showed that the intervention reduced symptoms of pain and challenging behaviour. Objective(s): To describe the experiences around the implementation of the intervention; to examine the extent to which the STA OP! intervention was delivered and implemented as intended (at the level of the team, and the individual resident/professional); and to understand factors influencing the implementation process. Methods: A process evaluation was performed using a mixed-methods design encompassing several data sources. Quantitative data (i.e. from the written evaluations by healthcare professionals, management, and the research database) were analysed using descriptive statistics. Qualitative data (i.e. semi-structured interviews, notes, completed intervention forms, and written evaluations) were analysed according to the principles of thematic analysis. The implementation process and the influencing factors were categorised according to the i) organisational level, ii) the team level, and iii) the level of the individual resident/professional. Results: In total, 39.2% of the residents with pain and/or challenging behaviour were treated following the stepwise approach of the STA OP! intervention. The training manual and forms used were found to be relevant and feasible. Factors inhibiting the implementation process at the i) organisational level concerned instability of the organisation and the team (e.g. involvement in multiple projects/new innovations, staff turnover/absence of essential disciplines, and/or high workload). At the team level (ii), we found that presence of a person with a motivational leadership style facilitated the implementation. Also, interdisciplinary cooperation through the design/setting of the multidisciplinary training, securing the intervention by use of clear agreements, and written reporting or transfers facilitated implementation. At the individual level (iii), perceived value of the stepwise working method, and enhanced awareness facilitated the implementation. Conclusion: Although the intervention was not implemented as planned, the intervention empowered healthcare professionals and increased their awareness of the signals of pain and challenging behaviour. Future implementation of the intervention should start on units with a motivational leader, and specific features of the organisation and the team should be considered to facilitate implementation, e.g. stability, support, and shared focus to change. |
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| format | Article |
| id | doaj.art-0ded25c7d8d14987beaa9e3ef3bd27ac |
| institution | Directory Open Access Journal |
| issn | 1568-4156 |
| language | English |
| last_indexed | 2024-12-17T20:25:23Z |
| publishDate | 2018-09-01 |
| publisher | Ubiquity Press |
| record_format | Article |
| series | International Journal of Integrated Care |
| spelling | doaj.art-0ded25c7d8d14987beaa9e3ef3bd27ac2022-12-21T21:33:48ZengUbiquity PressInternational Journal of Integrated Care1568-41562018-09-0118310.5334/ijic.39733662Implementation of a Stepwise, Multidisciplinary Intervention for Pain and Challenging Behaviour in Dementia (STA OP!): A Process EvaluationMarjoleine J.C. Pieper0Wilco P. Achterberg1Jenny T. van der Steen2Anneke L. Francke3Amsterdam Public Health (APH) research institute, van der Boechorststraat 7, 1081 BT Amsterdam; Department of General Practice & Elderly Care Medicine, VU University Medical Center Amsterdam, van der Boechorststraat 7, 1081 BT Amsterdam; Department of Public Health and Primary Care, Leiden University Medical Center, Post zone V0-P, 2300 RC LeidenAmsterdam Public Health (APH) research institute, van der Boechorststraat 7, 1081 BT Amsterdam; Department of Public Health and Primary Care, Leiden University Medical Center, Post zone V0-P, 2300 RC LeidenDepartment of Public Health and Primary Care, Leiden University Medical Center, Post zone V0-P, 2300 RC LeidenAmsterdam Public Health (APH) research institute, van der Boechorststraat 7, 1081 BT Amsterdam; Department of Public and Occupational Health, VU University Medical Center Amsterdam, van der Boechorststraat 7, 1081 BT Amsterdam; Netherlands Institute for Health Services Research (NIVEL), 3500 BN UtrechtBackground: A stepwise, multidisciplinary and multicomponent intervention (called STA OP!) was implemented in Dutch nursing home units, which included a comprehensive multidisciplinary team training. A cluster-randomised controlled trial showed that the intervention reduced symptoms of pain and challenging behaviour. Objective(s): To describe the experiences around the implementation of the intervention; to examine the extent to which the STA OP! intervention was delivered and implemented as intended (at the level of the team, and the individual resident/professional); and to understand factors influencing the implementation process. Methods: A process evaluation was performed using a mixed-methods design encompassing several data sources. Quantitative data (i.e. from the written evaluations by healthcare professionals, management, and the research database) were analysed using descriptive statistics. Qualitative data (i.e. semi-structured interviews, notes, completed intervention forms, and written evaluations) were analysed according to the principles of thematic analysis. The implementation process and the influencing factors were categorised according to the i) organisational level, ii) the team level, and iii) the level of the individual resident/professional. Results: In total, 39.2% of the residents with pain and/or challenging behaviour were treated following the stepwise approach of the STA OP! intervention. The training manual and forms used were found to be relevant and feasible. Factors inhibiting the implementation process at the i) organisational level concerned instability of the organisation and the team (e.g. involvement in multiple projects/new innovations, staff turnover/absence of essential disciplines, and/or high workload). At the team level (ii), we found that presence of a person with a motivational leadership style facilitated the implementation. Also, interdisciplinary cooperation through the design/setting of the multidisciplinary training, securing the intervention by use of clear agreements, and written reporting or transfers facilitated implementation. At the individual level (iii), perceived value of the stepwise working method, and enhanced awareness facilitated the implementation. Conclusion: Although the intervention was not implemented as planned, the intervention empowered healthcare professionals and increased their awareness of the signals of pain and challenging behaviour. Future implementation of the intervention should start on units with a motivational leader, and specific features of the organisation and the team should be considered to facilitate implementation, e.g. stability, support, and shared focus to change.https://www.ijic.org/articles/3973behaviourdementiaHealth Plan Implementationinterventionnursing homespainprogram evaluationprocess evaluation |
| spellingShingle | Marjoleine J.C. Pieper Wilco P. Achterberg Jenny T. van der Steen Anneke L. Francke Implementation of a Stepwise, Multidisciplinary Intervention for Pain and Challenging Behaviour in Dementia (STA OP!): A Process Evaluation International Journal of Integrated Care behaviour dementia Health Plan Implementation intervention nursing homes pain program evaluation process evaluation |
| title | Implementation of a Stepwise, Multidisciplinary Intervention for Pain and Challenging Behaviour in Dementia (STA OP!): A Process Evaluation |
| title_full | Implementation of a Stepwise, Multidisciplinary Intervention for Pain and Challenging Behaviour in Dementia (STA OP!): A Process Evaluation |
| title_fullStr | Implementation of a Stepwise, Multidisciplinary Intervention for Pain and Challenging Behaviour in Dementia (STA OP!): A Process Evaluation |
| title_full_unstemmed | Implementation of a Stepwise, Multidisciplinary Intervention for Pain and Challenging Behaviour in Dementia (STA OP!): A Process Evaluation |
| title_short | Implementation of a Stepwise, Multidisciplinary Intervention for Pain and Challenging Behaviour in Dementia (STA OP!): A Process Evaluation |
| title_sort | implementation of a stepwise multidisciplinary intervention for pain and challenging behaviour in dementia sta op a process evaluation |
| topic | behaviour dementia Health Plan Implementation intervention nursing homes pain program evaluation process evaluation |
| url | https://www.ijic.org/articles/3973 |
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