Facilitating implementation of research evidence (FIRE): A randomised controlled trial and process evaluation of two models of facilitation informed by the promoting action on research implementation in health services (PARIHS) framework

Background: The PARIHS framework proposes that successful implementation of research evidence results from the complex interplay between the evidence to be implemented, the context of implementation and the facilitation processes employed. Facilitation is defined as a role (the facilitator) and a process (facilitation strategies/methods). Empirical evidence comparing different facilitation approaches is limited; this paper reports a trial of two different types of facilitation represented in the PARIHS framework. Methods: A pragmatic cluster randomised controlled trial with embedded process evaluation was undertaken in 24 long-term nursing care settings in four European countries. In each country, sites were randomly allocated to standard dissemination of urinary incontinence guideline recommendations and one of two types of external-internal facilitation, labelled Type A and B. Type A facilitation was a less resource intensive approach, underpinned by improvement methodology; Type B was a more intensive, emancipatory model of facilitation, informed by critical social science. The primary outcome was percentage documented compliance with guideline recommendations. Process evaluation was framed by realist methodology and involved quantitative and qualitative data collection from multiple sources. Findings: Quantitative data were obtained from reviews of 2313 records. Qualitative data included over 332 hours of observations of care; 39 hours observation of facilitation activity; 471 staff interviews; 174 resident interviews; 120 next of kin/carer interviews; and 125 stakeholder interviews. There were no significant differences in the primary outcome between study arms and all study arms improved over time. Process data revealed three core mechanisms that influenced the trajectory of the facilitation intervention: alignment of the facilitation approach to the needs and expectations of the internal facilitator and colleagues; engagement of internal facilitators and staff in attitude and action; and learning over time. Data from external facilitators demonstrated that the facilitation interventions did not work as planned, issues were cumulative and maintenance of fidelity was problematic. Implications for D&I Research: Evaluating an intervention - in this case facilitation - that is fluid and dynamic within the methodology of a randomised controlled trial is complex and challenging. For future studies, we suggest a theoretical approach to fidelity, with a focus on mechanisms, as opposed to dose and intensity of the intervention

Technologie, onze zorg

Het lectoraat wil de rol en de bijdrage van technologie aan zorg in onze ouder wordende samenleving onderzoeken vanuit een persoonsgerichte visie. Met de titel Technologie, onze zorg geef ik uitdrukking aan mijn relationele mensbeeld binnen de zorgpraktijk. Hierin wordt houdbare zorg gecreëerd door een combinatie van zelfzorg, mantelzorg, zorg door vrijwilligers én professionele zorg. Persoonsgerichtheid is essentieel om recht te doen aan eenieder die hierin is betrokken. Technologie biedt kansen om in deze ‘samenzorg’ een bemiddelende rol te spelen. Voorbeelden zijn surveillance-, zelfredzaamheidsondersteunende-, belevingsgerichte-, informatie- en communicatietechnologie. De implementatie van deze vormen van technologie vraagt om een aanpak op verschillende niveaus: Micro-niveau: het betekent voor het primaire proces, daar waar zorgvraag en zorgaanbod elkaar ontmoeten, dat we denken en handelen vanuit wederzijds respect en gedeelde besluitvorming; Meso-niveau: via regionale samenwerking tussen zorg-, onderwijs- en onderzoeksorganisatie en bedrijfsleven kunnen we ván en mét elkaar leren; Macro-niveau: overheidsbeleid kan randvoorwaarden scheppen om een persoonsgerichte benadering van technologie in samenzorg te stimuleren

A case study of learning to become a PD facilitator: \u27climbing the tree\u27

This article describes and relates to classic and emerging theory, and the journey of one person, based at a Dutch university (Fontys University of Applied Sciences), towards becoming a facilitator concerned with transformational teaching practice. Following on from some background on facilitation within the context of practice development, the article summarizes and offers illustrations from a critical conversation between the two authors. Three themes relevant to climbing the tree were identified as (1) working with clarified values and beliefs; (2) movement: moving from technical single issues to working with complex questions and multiple practice development principles and (3) construction and reconstruction of a personalized embodied facilitation framework. These are used as a structure for the discussion. The case study concludes that becoming a facilitator, rather than the technical application of facilitation techniques and tools, is a continuous journey, with personal or internal dimensions where the person/facilitator is part of the learning process

I have the world's best job' - staff experience of the advantages of caring for older people

Rationale: Besides a growing demand for safe high-quality care for older people, long-term care (LTC) often struggles to recruit appropriately qualified nursing staff. Understanding what LTC staff value in their work may contribute to a more comprehensive understanding of what can attract staff and support person-centred care. Aim: To explore staff experience of the advantages of working in LTC settings for older people. Methods: Narrative descriptions of 85 LTC staff in Ireland, the Netherlands and Sweden on what they value in their work were analysed with qualitative content analysis. Ethics: Ethical approval was obtained according to the requirements of each country, and participants provided informed consent prior to the individual interviews. Findings: Working in LTC signifies bonding with the older people residing there, their next of kin and the team members. It means autonomy in one's daily tasks amalgamated with being a part of an affirmative team. Participants reported a sense of accomplishment and fulfilment; caring meant consideration and recognition of the older people and the relationships formed, which provided for professional and personal growth. The sharing of compassion between staff and residents indicated reciprocity of the relationship with residents. Study limitations: The findings may be transferable to LTC in general although they address only the positive aspects of caring for older people and only the experiences of those staff who had consented to take part in the study. Conclusions: The findings add to what underpins the quality of care in nursing homes: compassion in the nurse-resident relationship and person-centred care in LTC. They indicate reciprocity in the relations formed that may contribute to the empowerment of older people, but further studies are needed to explore this in more detail. 2015 Nordic College of Caring Science.sch_nur30pub4003pub

A Bridge Over Turbulent Waters: Illustrating the Interaction Between Managerial Leaders and Facilitators When Implementing Research Evidence

Background: Emerging evidence focuses on the importance of the role of leadership in successfully transferring research evidence into practice. However, little is known about the interaction between managerial leaders and clinical leaders acting as facilitators (internal facilitators [IFs]) in this implementation process. Aims: To describe the interaction between managerial leaders and IFs and how this enabled or hindered the facilitation process of implementing urinary incontinence guideline recommendations in a local context in settings that provide long-term care to older people. Methods: Semistructured interviews with 105 managers and 22 IFs, collected for a realist process evaluation across four European countries informed this study. An interpretive data analysis unpacks interactions between managerial leaders and IFs. Results: This study identified three themes that were important in the interactions between managerial leaders and IFs that could hinder or support the implementation process: realising commitment negotiating conditions and encouragement to keep momentum going. The findings revealed that the continuous reciprocal relationships between IFs and managerial leaders influenced the progress of implementation, and could slow the process down or disrupt it. A metaphor of crossing a turbulent river by the building of a bridge emerged as one way of understanding the findings. Linking Evidence to Action: Our findings illuminate a neglected area, the effects of relationships between key staff on implementing evidence into practice. Relational aspects of managerial and clinical leadership roles need greater consideration when planning guideline implementation and practice change. In order to support implementation, staff assigned as IFs as well as stakeholders like managers at all levels of an organisation should be engaged in realising commitment, negotiating conditions, and keeping momentum going. Thus, communication is crucial between all involved. 2016 Sigma Theta Tau International.sch_nur13pub4287pub