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. 2017 Sep 18:16:55.
doi: 10.1186/s12912-017-0244-0. eCollection 2017.

A mixed method study of an education intervention to reduce use of restraint and implement person-centered dementia care in nursing homes

Frode F Jacobsen  1   2   3 , Tone Elin Mekki  1   2 , Oddvar Førland  1   2   3 , Bjarte Folkestad  1   4 , Øyvind Kirkevold  5   6 , Randi Skår  7 , Eva Marie Tveit  1   8 , Christine Øye  1   2
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A mixed method study of an education intervention to reduce use of restraint and implement person-centered dementia care in nursing homes

Frode F Jacobsen et al. BMC Nurs. .

Abstract

Background: People living with dementia in nursing homes are most likely to be restrained. The primary aim of this mixed-method education intervention study was to investigate which factors hindered or facilitated staff awareness related to confidence building initiatives based on person-centred care, as an alternative to restraint in residents with dementia in nursing homes. The education intervention, consisting of a two-day seminar and monthly coaching sessions for six months, targeted nursing staff in 24 nursing homes in Western Norway. The present article reports on staff-related data from the study.

Methods: We employed a mixed-method design combining quantitative and qualitative methods. The P-CAT (Person-centred Care Assessment Tool) and QPS-Nordic (The General Nordic questionnaire for psychological and social factors at work) instruments were used to measure staff effects in terms of person-centred care and perception of leadership. The qualitative data were collected through ethnographic fieldwork, qualitative interviews and analysis of 84 reflection notes from eight persons in the four teams who facilitated the intervention. The PARIHS (Promoting Action on Research Implementation in Health Services) theoretical framework informed the study design and the data analysis. Six nursing homes were selected for ethnographic study post-intervention.

Results: Qualitative data indicated increased staff awareness related to using restraint - or not- in the context of person-centered care. A slight increase in P-CAT supported these findings. Thirteen percent of the P-CAT variation was explained by institutional belonging. Qualitative data indicated that whether shared decisions of alternative measures to restraint were applied was a function of dynamic interplay between facilitation and contextual elements. In this connection, the role of the nursing home leaders appeared to be a pivotal element promoting or hindering person-centered care. However, leadership-staff relations varied substantially across individual institutions, as did staff awareness related to restraint and person-centeredness.

Conclusions: Leadership, in interplay with staff culture, turned out to be the most important factor hindering or promoting staff awareness related to confidence building initiatives, based on person-centered care. While quantitative data indicated variations across institutions and the extent of this variation, qualitative data offered insight into the local processes involved. A mixed method approach enabled understanding of dynamic contextual relationships.

Trial registration: The trial is registered at Clinical Trials gov. reg. 2012/304 NCT01715506.

Keywords: Dementia care; Education intervention; Implementation research; Leadership; Mixed methods; Nursing home staff; Person-centred care; Restraint.

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Conflict of interest statement

Ethics approval and consent to participate

The MEDCED study was approved by the Regional Committee for Medical and Health Research Ethics in Norway (approval number 2012/304/REK vest, approved 28.03.2012), and information about the study was given to all staff and resident participants including collection of informed consent forms. All nursing homes and informants are anonymized. Ethical approval for the study with the facilitators was obtained from the Norwegian Social Science Data Services (Approval number 27399/3/MAB, approved 15.07.2011).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Adjusted predictions with 95% Cls
See this image and copyright information in PMC

References

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