Background
Methods
Design
Characteristic | Stroke care pathway | Fractured neck of femur care pathway | ||||
---|---|---|---|---|---|---|
Acute Stroke Unit
|
Rehab. in community
| Post-op. | Post-op. | Rehab. | Rehab. in community | |
Number of beds |
56
|
31
a
| 34 | 34 | 28 | 31a
|
Number of staff |
60-70
b
|
50
c
| 39–41 | 36–38 | 39 | 50c
|
Interventions
Stroke care pathway
| Fractured neck of femur care pathwaya
| |||||
---|---|---|---|---|---|---|
Acute Stroke
|
Rehab.
c
in community
| Post-opb ward | Post-op.b ward | Rehab.c ward | Rehab.c in community | |
Staff trained as local Trainers | ||||||
Number of staff |
3
|
9
d
| 5 | 4 | 4 | 9d
|
Designation of the trainers |
2 RNs
1 OT
|
2 RNs
5 CSWs
2 CMs
| 2 RNs 2 CSWs 1H | 2 RNs 2 CSWs | 2 RNs 2 CSWs | 2 RNs 5 CSWs 2 CMs |
Follow-up support provided to the local Trainers between January–October 2013 | ||||||
Outreach: number of drop-in sessions |
4
|
1
d
| 8 | 8 | 8 | 1d
|
Feedback: verbal and written reports at half-way and end |
√
|
√
| √ | √ | √ | √ |
Adaptation: additional activities |
Provided staff notices about mixed diet consistencies
|
Joint teaching with the catering team
| Prepared resource box with equipment to deliver the training Co-led a funding bid to buy specialist dysphagia and adapted crockery/cutlery | Joint teaching with the catering team | ||
Training delivered by the trainers at Awareness and Assistant Dysphagia Practitioner levels | ||||||
Formal: staff trained by ward based Trainers at 6 months |
20–30
e
|
2
d
| 0 | 15 (Awareness level) | 0 | 2d
|
Formal: number of staff trained by 3 Education Leadsa at 10 months |
-
|
-
| Surgical Services Directorate 176 RNs 97 CSWs | - | ||
Informal: sharing knowledge, self-report and testimony from others |
√
|
√
| √ | √ | √ | √ |
Participants
Data collection methods
Analysis
Results
Demographic details
Organisation wide
| Stroke care pathway |
Fractured neck of femur care pathway
| Rehabilitation facility in the community (both care pathways) | |
---|---|---|---|---|
Role |
4 Education Strategic Leads
3 Professional Strategic Leads
1 external
| 2 Trainers 2 Clinical Leads 1 Education Lead |
8 Trainers
3 Education Leads
1 Clinical Lead
| 2 Trainers 3 Clinical Leads |
Profession |
4 RNs
2 SLTs
2 Others
| 4 RNs 1 OT |
7 RNs
4 CSWs
1 Other
| 2 RNs 1 SLT 1 Dietitian 1 Other |
Gender |
6 Female
2 Male
| 4 Female 1 Male |
8 Female
4 Male
| 4 Female 1 Male |
Tenure in current post |
˂ 12 months: 1
1–5 years: 3
6–10 years: 2
˃11 years: 1
NR: 1
a
| ˂ 12 months:1 1–5 years: 3 ˃11 years: 1 |
˂ 12 months:1
1–5 years: 7
6–10 years: 2
˃11 years: 2
| 1–5 years: 4 ˃11 years: 1 |
Processual approach
Stakeholder response
Critical junctures
Temporal dimension
April 2011 | May-August 2011 | September 2011 | October 2011 | November 2011 | December 2011 | |
---|---|---|---|---|---|---|
Hierarchical control | Findings from first study [21] presented to the Stroke Management Team | Targeted dissemination of findings to hospital and community staff | Findings presented to the Nutrition Group | Findings presented to the Nurse Leaders | Findings presented to the Stroke Management Team | Task and finish group set up by the Nutrition Group |
Research | - | - | - |
a
Starting point: sustainability in stroke unit
|
Exploring research ideas about spread and sustainability
|
January 2012 | February 2012 | March 2012 | April 2012 | May 2012 | June 2012 | |
---|---|---|---|---|---|---|
Hierarchical control | Findings presented to the Allied Health Professionals Quality Group | - |
aNutrition Group approved the recommendations from the first study | Stroke unit task and finish group meeting | - | - |
Participatory adaptation |
-
| - | - | - | - | - |
Research
|
Reviewing literature
|
Reviewing literature
| - |
Developing proposal
|
Developing proposal
|
Developing proposal
|
July 2012 | August 2012 | September 2012 | October 2012 | November 2012 | December 2012 | |
Hierarchical control |
aDysphagia included in the Essential Skills Log Book for newly qualified Registered Nurses (RNs) |
a Nurse Leaders approved the recommendations about using the Dysphagia Framework | - | Stroke unit task and finish group meeting |
aDirective to include in induction and training for nursing staff in Surgical Services Directorate | - |
Participatory adaptation | - | - | - | - | - | - |
Research
|
Ethical approval
|
-
|
Obtaining research governance
|
Research governance approval
|
Data collection: mealtime observations
|
Mealtime observations and knowledge & attitude survey
|
Research set-up meetings
|
January 2013 | February 2013 | March 2013 | April 2013 | May 2013 | June 2013 | |
---|---|---|---|---|---|---|
Hierarchical control | Dysphagia in local induction and annual training programme for nursing staff in surgical services | - | Dysphagia master classes in induction for new qualified Registered Nurses | - | - | - |
Participatory adaptation |
Train-the-trainer sessions; outreach support visits
|
Train-the-trainer sessions; outreach support visits; providing staff notices about mixed consistencies (acute stroke)
|
Train-the-trainer sessions; outreach support visits
|
Feedback meetings and written report to both care pathways; outreach support visits
|
Feedback meetings; outreach support visits; providing training resource materials (post-op fractured neck of femur NoF)
|
Outreach support visit co-teaching (community rehabilitation unit)
|
Research | Mealtime observations | Mealtime observations | - | - | Mealtime observations | Mealtime observations |
July 2013 | August 2013 | September 2013 | October 2013 | November–December 2013 | January 2014 | |
Hierarchical control |
Dysphagia master classes in induction for new RNs
|
-
|
-
|
Dysphagia master classes in induction for new RNs
|
Findings and preliminary recommendations agreed by research management group, including patient /public members
|
Findings presented to the Nutrition Group. Approved recommendations.
|
a
Dysphagia in annual up-date training for OTs and PTs
| ||||||
Participatory adaptation | - | - | Extra train-the-trainer session for a new trainer (post-op NoF) | Written feedback; co-led funding bid for ward specialist equipment (NoF) | Extra train-the-trainer session for 2 new trainers in community setting | Train-the-trainer session requested by new staff given this role (stroke) |
Research
|
Mealtime observations
Knowledge & attitude survey
Interviews
|
Interviews
Data analysis
|
Interviews
Data analysis
Team meeting: headline findings
|
Interviews
Data synthesis about spread and sustainability
|
Member checking with the research management group
|
Executive summary sent to all participants
|