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Lisiecka D, Kearns Á, Evans W, Farrell D. Aspiration pneumonia in nursing literature-a mapping review. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1393368. [PMID: 39113687 PMCID: PMC11304538 DOI: 10.3389/fresc.2024.1393368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/03/2024] [Indexed: 08/10/2024]
Abstract
Introduction Aspiration pneumonia (AP) is an infection of the lungs caused by inhalation of material. The reported incidences vary across literature and clinical populations and is associated with high morbidity and mortality. Management of AP is best carried out by a multidisciplinary team. Methods This aim of this review was to collate and describe the available evidence on AP to develop a greater understanding of the concept of AP as it is represented in the nursing literature. As a collaborative team, we undertook the six stages of a systematic mapping review. We searched for the term aspiration pneumonia in 200 peer reviewed nursing journals across 10 databases, over a ten-year period (2013-2023). Results In this review, 293 papers were coded. Dysphagia, oral health and tube feeding emerged as the most frequent risk factors for AP, and the most reported factors for preventing this condition. Mortality was the most commonly described consequence of AP, followed by hospitalisations and morbidity. Multiple management approaches were reported including dysphagia assessment, risk evaluation, oral care and texture modification of food and fluids. The role of nurses and interprofessional collaborations were described. Discussion Despite limited evidence related to the topic of AP in the nursing literature, the complexity of the causes, prevention, management and consequences of AP emerged. Certain factors, such as dysphagia, oral health, and tube feeding, were described under prevention, cause and management of AP. The importance of multidisciplinary approach in the management and prevention of AP was presented.
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Affiliation(s)
- Dominika Lisiecka
- Department of Nursing and Healthcare Sciences, Munster Technological University—Kerry Campus, Tralee, Ireland
- Kerry Speech & Language Therapy Clinic, Tralee, Ireland
| | - Áine Kearns
- Health Research Institute, School of Allied Health, University of Limerick, Limerick, Ireland
| | - William Evans
- Department of Nursing and Healthcare Sciences, Munster Technological University—Kerry Campus, Tralee, Ireland
| | - Dawn Farrell
- Department of Nursing and Healthcare Sciences, Munster Technological University—Kerry Campus, Tralee, Ireland
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Windle A, Marshall A, de la Perrelle L, Champion S, Ross PD, Harvey G, Davy C. Factors that influence the implementation of innovation in aged care: a scoping review. JBI Evid Implement 2023; 22:02205615-990000000-00072. [PMID: 38153118 PMCID: PMC11163893 DOI: 10.1097/xeb.0000000000000407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
OBJECTIVE The objective of this scoping review is to identify factors that influence the implementation of innovation in aged care. INTRODUCTION Aged care is a dynamic sector experiencing rapid change. Implementation of innovations in aged care has received relatively little research attention compared to health care. INCLUSION CRITERIA This review included studies of any design, that examined the implementation of innovations in aged care settings. METHODS Searches were conducted in MEDLINE, CINAHL, AgeLine, and ProQuest Social Sciences Premium Collection for studies published between January 1, 2012 and December 31, 2022. The titles and abstracts of retrieved citations were screened by two independent reviewers. Full-text articles were screened by one reviewer to determine inclusion. Data were extracted in NVivo using a tool developed by the research team. Factors that influenced implementation were inductively coded, interpreted, and grouped into categories in a series of workshops. RESULTS Of the 2530 studies that were screened, 193 were included. Of the included papers, the majority (74%) related to residential aged care, 28% used an implementation theory or framework, and 15% involved consumers. Five key categories of factors influencing implementation were identified: organizational context including resourcing and culture; people's attitudes and capabilities; relationships between people; the intervention and its appropriateness; and implementation actions such as stakeholder engagement and implementation strategies. CONCLUSIONS Our findings can be used to develop practical resources to support implementation efforts, and highlight the importance of resourcing for successful implementation. Attention to community-based aged care, and greater engagement with theory and community is needed to promote research rigor, relevance and applicability.
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Affiliation(s)
- Alice Windle
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Amy Marshall
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Lenore de la Perrelle
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Stephanie Champion
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Paul D.S. Ross
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Gillian Harvey
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Carol Davy
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Rasmussen IL, Halberg N, Jensen PS. 'Why doesn't anyone ask me'? Patients' experiences of receiving, performing and practices of oral care in an acute Orthopaedic Department. Scand J Caring Sci 2023; 37:1079-1090. [PMID: 37231993 DOI: 10.1111/scs.13182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/12/2023] [Accepted: 05/07/2023] [Indexed: 05/27/2023]
Abstract
AIMS AND OBJECTIVES Oral care is an integrated part of everyday life. Within nursing, barriers related to providing oral care often lead to unmet caring needs. Poor oral care is associated with a risk of respiratory and cardiovascular complications during hospitalisation. Knowledge on patients' perspectives of maintaining or receiving oral care during admissions are limited. Following the Fundamentals of Care (FOC) framework, this study uses a person-centred approach to explore patients' perceptions and experiences of receiving or performing oral care, including the nursing staff's clinical practices. METHODOLOGICAL DESIGN AND JUSTIFICATION A focussed ethnographic approach was used to explore patients' perspectives and clinical practices during acute admissions in an Orthopaedic Department. ETHICS ISSUES AND APPROVAL The local Data Protection Agency and the Ethics Committee approved the study. RESEARCH METHODS, RESULTS AND CONCLUSIONS Data were collected in an Orthopaedic ward at a Copenhagen University hospital, Hvidovre, and consisted of 14 days of field observations of clinical practices and 15 patient interviews. Data were analysed inductively using qualitative content analysis. Two themes were identified. The first, 'The purpose of oral care is defined by the eye of the beholder', describes the social implications for the patients and how patients reject the assumption of oral care being a transgressive act. The second, 'The unspoken need', focus on the lack of dialogue, including the limited provision of oral care and how the nursing staff assesses patients' ability to perform oral care (in)dependently without including the patients. CONCLUSION Oral care is related to the patient's psychological and physical well-being and affects social appearance. When oral care is provided respectfully, patients do not experience oral care as a transgressive act. Nursing staff's self-assessments of the patients' (in)dependency to perform oral care risk leading to incorrect care. Developing and implementing interventions applicable to the clinical practice is needed.
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Affiliation(s)
- Isabella Lund Rasmussen
- The Research Unit of Orthopedic Nursing, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Nina Halberg
- The Research Unit of Orthopedic Nursing, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
- Center of Health Promotion and Health Strategies, Department of People and Technology, Roskilde University, Roskilde, Denmark
| | - Pia Søe Jensen
- The Research Unit of Orthopedic Nursing, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
- Center of Health Promotion and Health Strategies, Department of People and Technology, Roskilde University, Roskilde, Denmark
- Department of Clinical Research, Copenhagen University Hospital, Hvidovre, Denmark
- Research Unit Nursing and Health Care, Health, Aarhus University, Aarhus, Denmark
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Stark P, McKenna G, Wilson CB, Tsakos G, Brocklehurst P, Lappin C, Quinn B, Mitchell G. Interventions supporting community nurses in the provision of Oral healthcare to people living at home: a scoping review. BMC Nurs 2022; 21:269. [PMID: 36199087 PMCID: PMC9533519 DOI: 10.1186/s12912-022-01051-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Oral health is a critical issue for public health and poor oral health is associated with significant chronic health conditions and lower quality of life. There has been little focus on providing oral health care to people who receive care in their own homes, despite the high risk of poor oral health in older people. Nurses practicing in the community are well placed to deliver this care, but little is known about how to build this capability through education or training interventions. Methods A scoping review methodology was employed to find and review studies of oral health interventions involving populations of people receiving care in their own home or those nurses who deliver this care. The research question asked what previous research tells us about oral health interventions delivered by nurses in the community. Data was extracted for four areas: setting and type of intervention, patient outcomes, changes to nursing practice and implementation and process evaluations of interventions. Results Two thousand eighty papers were found from the searches, and only nine were ultimately deemed eligible for inclusion in the review. Included studies spanned community nursing for older people (n = 3) and health visiting or community nursing for children and infants (n = 6). Patient outcomes were generally positive, but this is based on a low level of evidence. Changes to practice including increased oral health care administered by nurses were found, but this required professional support to be sustainable. Conclusions This review has found that there is a clear gap in the research around interventions designed to be used by community nurses to improve oral health care for people receiving care in their own homes. The results also suggest that any future intervention must make use of a participatory, co-design approach and consider the complex setting of nursing practice in the community and the barriers to delivering this care, such as time pressure and lack of prior experience.
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Affiliation(s)
- Patrick Stark
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
| | - Gerry McKenna
- Centre for Public Health, Belfast, Queen's University Belfast, Belfast, Northern Ireland
| | | | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | | | - Caroline Lappin
- Department of Health, Castle Buildings, Stormont, Belfast, Northern Ireland
| | - Barry Quinn
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
| | - Gary Mitchell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland.
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Oda K, Boyd M, Parsons J, Smith M. Integrating oral care into nursing practice in care homes. Nurs Older People 2022; 34:27-34. [PMID: 35730481 DOI: 10.7748/nop.2022.e1406] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2022] [Indexed: 01/31/2023]
Abstract
This article details a narrative review that explored the barriers to and facilitators of integration of oral care into nursing practice in care homes to enhance nurses' delivery of oral care. Three themes were identified: gaps in oral care protocols and the complexity of nursing oral care; how interprofessional collaboration and education can improve oral care; and limitations and unresolved issues in nurses' oral care training. The review found that interprofessional collaboration and education were important in normalising oral care practice and nurse leadership in care homes. Nurse-led interprofessional oral care could enhance the quality of care in care homes by advancing interprofessional collaboration and education, coordinating care and improving organisational support.
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Affiliation(s)
- Keiko Oda
- Department of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- Department of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - John Parsons
- Department of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Moira Smith
- Department of Public Health, University of Otago, Wellington, New Zealand
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Weening-Verbree LF, Schuller AA, Zuidema SU, Hobbelen JSM. Evaluation of an Oral Care Program to Improve the Oral Health of Home-Dwelling Older People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127251. [PMID: 35742500 PMCID: PMC9223830 DOI: 10.3390/ijerph19127251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/04/2022] [Accepted: 06/09/2022] [Indexed: 11/17/2022]
Abstract
The aim of this study was to evaluate the impact of the implementation of an Oral Care Program on home care nurses’ attitudes and knowledge about oral health (care) and the impact on older people’s oral health. A pre–post study, without a control group, was conducted. A preventive Oral Care Program (OCP) was designed, focusing on home care nurses and older people, in collaboration with dental hygienists. Implementation was measured with questionnaires at baseline and after 6 months for home care nurses; for older people, implementation was measured at baseline and after 3 months with the Oral Health Assessment Tool and a questionnaire about oral (self) care between January 2018 and September 2019. Although the study design has limitations, the oral health of older people improved significantly after 3 months and the OCP was most beneficial for people with full dentures. The OCP improved knowledge and attitude of home care nurses. The program fitted well with the daily work routines of home care nurses. Individual-centered care plans for older people, education of home care nurses and the expertise of the dental hygienists have added value in home care nursing. Future implementations should focus on older people with natural teeth.
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Affiliation(s)
- Lina F. Weening-Verbree
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA Groningen, The Netherlands;
- Center for Dentistry and Oral Hygiene, University Medical Center Groningen, A. Deusinglaan 1, FB 21, 9713 AV Groningen, The Netherlands;
- Correspondence:
| | - Annemarie A. Schuller
- Center for Dentistry and Oral Hygiene, University Medical Center Groningen, A. Deusinglaan 1, FB 21, 9713 AV Groningen, The Netherlands;
- TNO the Netherlands Organisation for Applied Scientific Research, Schipholweg 77-89, 2316 ZL Leiden, The Netherlands
| | - Sytse U. Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, FA21, P.O. Box 196, 9700 AD Groningen, The Netherlands;
| | - Johannes S. M. Hobbelen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA Groningen, The Netherlands;
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, FA21, P.O. Box 196, 9700 AD Groningen, The Netherlands;
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Normalisation process theory and the implementation of a new glaucoma clinical pathway in hospital eye services: Perspectives of doctors, nurses and optometrists. PLoS One 2021; 16:e0255564. [PMID: 34339462 PMCID: PMC8328316 DOI: 10.1371/journal.pone.0255564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 07/20/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Normalisation process theory reports the importance of contextual integration in successfully embedding novel interventions, with recent propositions detailing the role that 'plasticity' of intervention components and 'elasticity' of an intended setting contribute. We report on the introduction of a clinical pathway assessing patient non-responsiveness to treatment for glaucoma and ocular hypertension. The aim of this study was to assess the feasibility of implementing the Cardiff Model of Glaucoma Care into hospital eye services, identifying any issues of acceptability for staff through the filter of normalisation process theory. METHODS A prospective observational study was undertaken in four hospital eye services. This incorporated detailed qualitative semi-structured interviews with staff (n = 8) to gather their perceptions on the intervention's usefulness and practicality. In addition, observational field notes of patient and staff consultations (n = 88) were collected, as well as broader organisational observations from within the research sites (n = 52). Data collection and analysis was informed by the normalisation process theory framework. RESULTS Staff reported the pathway led to beneficial knowledge on managing patient treatment, but the model was sometimes perceived as overly prescriptive. This perception varied significantly based on the composition of clinics in relation to staff experience, staff availability and pre-existing clinical structures. The most commonly recounted barrier came in contextually integrating into sites where wider administrative systems were inflexible to intervention components. CONCLUSIONS Flexibility will be the key determinant of whether the clinical pathway can progress to wider implementation. Addressing the complexity and variation associated with practice between clinics required a remodelling of the pathway to maintain its central benefits but enhance its plasticity. Our study therefore helps to confirm propositions developed in relation to normalisation process theory, contextual integration, intervention plasticity, and setting elasticity. This enables the transferability of findings to healthcare settings other than ophthalmology, where any novel intervention is implemented.
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Dalkin SM, Hardwick RJL, Haighton CA, Finch TL. Combining Realist approaches and Normalization Process Theory to understand implementation: a systematic review. Implement Sci Commun 2021; 2:68. [PMID: 34174966 PMCID: PMC8234627 DOI: 10.1186/s43058-021-00172-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Realist approaches and Normalization Process Theory (NPT) have both gained significant traction in implementation research over the past 10 years. The aim of this study was therefore to explore how the approaches are combined to understand problems of implementation, to determine the degree of complementarity of the two approaches and to provide practical approaches for using them together. METHODS Systematic review of research studies combining Realist and NPT approaches. Realist methodology is concerned with understanding and explaining causation, that is, how and why policies, programmes and interventions achieve their effects. NPT is a theory of implementation that explains how practices become normalised. Databases searched (January 2020) were ASSIA, CINAHL, Health Research Premium Collection via Proquest (Family Health Database, Health & Medical Collection, Health Management Database, MEDLINE, Nursing & Allied Health Database, Psychology Database, Public Health Database) and PsycARTICLES. Studies were included if the author(s) stated they used both approaches: a scientific Realist perspective applying the principles of Pawson and Tilley's Realist Evaluation or Pawson's Realist Synthesis and Normalization Process Theory either solely or in addition to other theories. Two authors screened records; discrepancies were reviewed by a third screener. Data was extracted by three members of the team and a narrative synthesis was undertaken. RESULTS Of 245 total records identified, 223 unique records were screened and 39 full-text papers were reviewed, identifying twelve papers for inclusion in the review. These papers represented eight different studies. Extent and methods of integration of the approaches varied. In most studies (6/8), Realist approaches were the main driver. NPT was mostly used to enhance the explanatory power of Realist analyses, informing development of elements of Contexts, Mechanisms and Outcomes (a common heuristic in realist work). Authors' reflections on the integration of NPT and Realist approaches were limited. CONCLUSIONS Using Realist and NPT approaches in combination can add explanatory power for understanding the implementation of interventions and programmes. Attention to detailed reporting on methods and analytical process when combining approaches, and appraisal of theoretical and practical utility is advised for advancing knowledge of applying these approaches in research. SYSTEMATIC REVIEW REGISTRATION Not registered.
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Affiliation(s)
- Sonia Michelle Dalkin
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
- Fuse (The Centre for Translational Research in Public Health), Newcastle upon Tyne, UK
| | | | - Catherine A. Haighton
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Tracy L. Finch
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
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Chu KY, Cockrell D, Naganathan V, Stanaway F, Wright F. Oral health status of newly admitted residents living in residential aged care. Aust Dent J 2021; 66:391-396. [PMID: 34146422 DOI: 10.1111/adj.12864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is important to understand whether older people are admitted into residential care with existing dental diseases or their oral health deteriorates while residing in residential care. There is, however, little research available exploring the oral health status of people newly admitted into residential care. Understanding this disease trend would lead to effective prevention and treatment strategies to be trialled and implemented prior to admission. In this cross-sectional study, we hypothesize that older people with one or more natural teeth might have poor oral health prior to admission to residential care. METHOD The study was carried out using the de-identified oral health assessment database of an established domiciliary oral health care program in metropolitan New South Wales, Australia. Four hundred and nine participants with mean participant age of 85.56 years from 13 facilities from 2015 to 2018 fulfilled the inclusion criteria for this study. CONCLUSION This study confirmed that dentate, newly admitted residents to residential care had pre-existing dental problems and oral health concerns. Almost half of the newly admitted residents had an unsatisfactory oral cleanliness score when examined in their residential care setting.
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Affiliation(s)
- K-Y Chu
- Centre for Education and Research on Ageing, University of Sydney, Concord West, New South Wales, Australia.,Department of Geriatric Medicine, Concord Repatriation General Hospital, Sydney Local Health District, Concord West, New South Wales, Australia
| | - D Cockrell
- Centre for Education and Research on Ageing, University of Sydney, Concord West, New South Wales, Australia.,Department of Geriatric Medicine, Concord Repatriation General Hospital, Sydney Local Health District, Concord West, New South Wales, Australia.,Discipline of Health Sciences (Oral Health), University of Newcastle, Ourimbah, New South Wales, Australia
| | - V Naganathan
- Centre for Education and Research on Ageing, University of Sydney, Concord West, New South Wales, Australia.,Department of Geriatric Medicine, Concord Repatriation General Hospital, Sydney Local Health District, Concord West, New South Wales, Australia.,Concord Clinical School of Medicine, University of Sydney, Concord West, New South Wales, Australia
| | - F Stanaway
- School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Fac Wright
- Centre for Education and Research on Ageing, University of Sydney, Concord West, New South Wales, Australia
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Hsu WC, Hsieh YP, Lan SJ. Home care aides' attitudes to training on oral health care. PLoS One 2021; 16:e0249021. [PMID: 33844695 PMCID: PMC8041167 DOI: 10.1371/journal.pone.0249021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 03/10/2021] [Indexed: 11/18/2022] Open
Abstract
This study investigated home care aides' (HCAs) oral health care experience, knowledge, and their intention to receive professional training, to explain and predict factors of their intention to receive such training. This cross-sectional study collected data through a structured questionnaire. HCAs affiliated with home care agencies in Taichung, Taiwan were recruited through purposive sampling. A total of 487 questionnaires were distributed from September to December 2015 with 280 valid responses collected (57.4%).This study predicted the factors of HCAs' intention to receive oral health care training through a decision tree analysis. The decision tree model classified the respondents with an accuracy of 77.5%. The optimal predictor variable was oral health care knowledge (χ2 = 66.662, p < 0.0001). Among the low-scoring respondents on oral health care knowledge, 76.4% were classified in the "uninterested" group, whereas 84.8% of the high scorers were classified in the "interested" group. The second best predictor variable was whether oral health care is part of the job responsibility (χ2 = 7.979, p = 0.007). Among those who answered Yes, 92.9% were in the interested group, as were 76.5% of those who answered No. It is recommended to add "disease and oral care-related content" and "safety protection, assessment, and usage of oral care tools during practical oral care process" to the oral healthcare training course content for HCAs in order to improve HCAs' oral healthcare knowledge and oral care skills. These research findings are valuable and may be taken into account in the future development of the in-service educational training of oral healthcare for HCAs.
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Affiliation(s)
- Wei-Chung Hsu
- Department of Radiation Oncology, Chung Kang Branch, Cheng—Ching General Hospital, Taichung, Taiwan
| | - Yen-Ping Hsieh
- Department of Long-term Care, National Quemoy University, Kinmen, Taiwan
- * E-mail:
| | - Shou-Jen Lan
- School of Basic Medical Science, Putian University, Putian, China
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Bergström A, Ehrenberg A, Eldh AC, Graham ID, Gustafsson K, Harvey G, Hunter S, Kitson A, Rycroft-Malone J, Wallin L. The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature. Implement Sci 2020; 15:68. [PMID: 32854718 PMCID: PMC7450685 DOI: 10.1186/s13012-020-01003-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework. METHODS This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail. RESULTS The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated. CONCLUSIONS In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.
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Affiliation(s)
- Anna Bergström
- Department of Women’s and Children’s health, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Uppsala, Sweden
- Institute for Global Health, University College London, London, UK
| | - Anna Ehrenberg
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Ann Catrine Eldh
- Department of Medicine and Health, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kazuko Gustafsson
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- University Library, Uppsala University, Uppsala, Sweden
| | - Gillian Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Green Templeton College, University of Oxford, Oxford, UK
| | - Jo Rycroft-Malone
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancashire, UK
| | - Lars Wallin
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Palm R, Hochmuth A. What works, for whom and under what circumstances? Using realist methodology to evaluate complex interventions in nursing: A scoping review. Int J Nurs Stud 2020; 109:103601. [PMID: 32590248 DOI: 10.1016/j.ijnurstu.2020.103601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/03/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The Medical Research Council's (MRC) framework recommends basing every evaluation of a complex intervention on a theory that explains WHY an intervention works instead of focusing exclusively on the identification IF an intervention works. Theory-based evaluation approaches such as realist evaluations are promising in this respect. The aim of this scoping review is to examine current scientific literature with regard to the use of realist methodology in studies that evaluate complex nursing interventions. We also seek to answer the question whether realist evaluation studies of complex nursing interventions are embedded in the Medical Research Council's framework. METHODS A systematic database search in MEDLINE and CINAHL supplemented with snowballing techniques and a hand search in relevant nursing journals were performed between January and February 2018 and updated in July 2019. Both authors independently screened the title / abstract of studies that were initially identified and appraised the full texts if inclusion criteria were fulfilled. Inclusion criteria were the explicit use of realist methodology and a focus on the development or evaluation of complex nursing interventions. Results were summarized narratively. RESULTS A total of 28 articles from 22 studies, published between 2010 and 2019, were included. The majority of the studies included originate in the UK. Realist methodology was used by a variety of nursing disciplines, including midwifery, community / public health, critical care, palliative care, gerontological nursing, psychiatric nursing / mental health, and infection control. Study designs included case studies and realist reviews; two studies were conducted alongside a randomized controlled trial. All studies included used more than one method to develop their results; the majority of methods were qualitative by nature. Thirteen of the studies included aimed to develop a theory about what works, for whom and under what circumstances regarding the investigated complex nursing intervention. One study was clearly embedded in the Medical Research Council's framework. CONCLUSION Realist evaluation broadens the methodologies that have traditionally been used in nursing. Conceptual clarity on its principal tenets is still needed, as well as the methods used to assess them. Nursing scientists should be more critical when using novel methodology and contribute to academic debates about limitations. Embedding realist evaluations into the Medical Research Council's framework is in its infancy in nursing and needs more contributions in order to develop a common academic position within the profession. Tweetable abstract Realist methodology in nursing - review of the use, methods, limitations and embedding into the Medical Research Council's framework.
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Affiliation(s)
- Rebecca Palm
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Stockumer Str. 12, 58453 Witten, Germany; German Center for Neurodegenerative Diseases, Site Witten, Stockumer Str. 12, 58453 Witten, Germany.
| | - Alexander Hochmuth
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Stockumer Str. 12, 58453 Witten, Germany
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