Background
Methods
Study design
Intervention
No. of nursing homes | Month | |||||
---|---|---|---|---|---|---|
1–3 | 4–6 | 7–9 | 10–12 | 13–15 | 16–19 | |
1 | I | I | F | F | F | F |
1 | C | I | I | F | F | F |
1 | C | C | I | I | F | F |
1 | C | C | C | I | I | F |
2 | C | C | C | C | I | I |
Parallel implementation strategy
When | Week | Components of intervention and implementation strategy | Participants | Workload (total of 64.5 h) |
---|---|---|---|---|
4 weeks before the start of the intervention | Kick-off meeting with senior management | Representatives of senior management, quality management and head nurses of nursing teams | 3 h | |
Kick-off meeting with nursing staff | Nursing staff of nursing teams | 1.5 h | ||
1st coaching session with steering group | Senior management and head nurses of nursing teams | 3 h | ||
Weeks 1–10 (3 months) | 1 | In-service training on ‘Dementia and BPSD’ | All staff including nursing teams | 3 h |
2 | In-service training on WELCOME-IdA, 1st day | Managers of nursing teams, head nurses, nursing teams and moderators | 6 h (3 h per team) | |
In-service training on ‘Moderation skills’, 1st day | 2 people from each nursing team for a total of 4 people | 6 h | ||
3, 4 | In-service training on WELCOME-IdA, 2nd day | Managers of nursing teams, head nurses, nursing teams and moderators | 6 h (3 h per team) | |
In-service training on ‘Moderation skills’, 2nd day | 2 people from each nursing team for a total of 4 people | 6 h | ||
5 | 1st on-the-job training session on WELCOME-IdA | Nursing teams and moderator | 6 h (3 h per team) | |
6 | 2nd on-the-job training session on WELCOME-IdA | Nursing teams and moderator | 6 h (3 h per team) | |
7 | 3rd on-the-job training session on WELCOME-IdA | Nursing teams and moderator | 6 h (3 h per team) | |
8 | 2nd coaching session of steering group | Senior management and head nurses of nursing teams | 3 h | |
9 | 4th on-the-job training session on WELCOME-IdA | Nursing teams and moderator | 6 h (3 h per team) | |
10 | 3rd coaching session of steering group | Senior management and head nurses of nursing teams | 3 h | |
Weeks 13–28 (4 months) | 13–16 | 1st WELCOME-IdA off-the-job-training phase | Nursing teams and moderator | 60–90 min |
17–20 | 2nd WELCOME-IdA off-the-job-training phase | Nursing teams and moderator | 60–90 min | |
21–24 | 3rd WELCOME-IdA off-the-job-training phase | Nursing teams and moderator | 60–90 min | |
25–28 | 4th WELCOME-IdA off-the-job-training phase | Nursing teams and moderator | 60–90 min |
Data collection
Context
Recruitment and target populations reached
Delivery of intervention and implementation strategy
Data analysis
Results
Context
Structural characteristics of the NHs and units
Feature | Nursing home | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
NHs enrolled at baseline | E29 | E79 | E89 | E75 | E82 | E50 | ||||||
Nursing home size (n) | 79 | 100 | 80 | 80 | 54 | 100 | ||||||
Number of units (n) | 3 | 4 | 2 | 2 | 2 | 2 | ||||||
Residents’ level of care dependency [%] | ||||||||||||
0 | 3.8 | 0 | 2.5 | 0 | 0 | 1.0 | ||||||
1 (low) | 29.1 | 36.0 | 32.5 | 42.5 | 42.6 | 35.0 | ||||||
2 (moderate) | 35.4 | 25.0 | 47.5 | 30.0 | 42.6 | 40.0 | ||||||
3 (severe) | 29.1 | 33.0 | 15.0 | 25.0 | 9.3 | 20.0 | ||||||
3+ (very severe) | 2.5 | 6.0 | 2.5 | 1.3 | 0 | 1.0 | ||||||
Number of total nursing staff (n) | 51 | 59 | 53 | 60 | 38 | 50 | ||||||
Number of registered nurses* (n) | 29 | 30 | 21 | 21 | 17 | 23 | ||||||
New employees, last 3 months | 2 | 1 | 4 | 1 | 2 | 5 | ||||||
Employees resigned, last 3 months | 1 | 1 | 1 | 0 | MD | 3 | ||||||
Units enrolled at baseline | Unit 1 | Unit 2 | Unit 1 | Unit 2 | Unit 1 | Unit 2 | Unit 1 | Unit 2 | Unit 1 | Unit 2 | Unit 1 | Unit 2 |
Unit size (n) | 26 | 26 | 26 | 26 | 41 | 39 | 40 | 40 | 30 | 24 | 49 | 51 |
Residents´level of care [%] | ||||||||||||
0 | 0 | 0 | 0 | 0 | 2.4 | 2.6 | 0 | 0 | 0 | 0 | 0 | 0 |
1 (mild) | 34.6 | 26.9 | 26.9 | 42.3 | 34.1 | 25.6 | 37.5 | 47.5 | 46.7 | 37.5 | 34.7 | 37.3 |
2 (moderate) | 30.8 | 42.3 | 19.2 | 34.6 | 51.2 | 46.2 | 25.0 | 35.0 | 40.0 | 45.8 | 38.8 | 43.1 |
3 (severe) | 26.9 | 30.8 | 42.3 | 23.1 | 7.3 | 23.1 | 37.5 | 12.5 | 13.3 | 4.2 | 24.5 | 15.7 |
3+ (very severe) | 7.7 | 0 | 11.5 | 0 | 2.4 | 2.6 | 0 | 2.5 | 0 | 0 | 0 | 2.0 |
Total nursing staff (n) | 17 | 18 | 20 | 13 | 18 | 23 | 25 | 26 | 20 | 18 | 25 | 27 |
Number of registered nurses (n) | 10 | 9 | 7 | 8 | 7 | 9 | 8 | 8 | 9 | 8 | 11 | 11 |
Sick leave of the total nursing staff [hrs], last 3 months | 297 | 495 | 341 | 386 | 347.6 | 509.4 | 458 | 358.6 | 328 | 318 | 1080 | 1410 |
Advanced training of the total nursing staff [hrs], last 3 months | 124 | 182 | 71 | 46 | 88.6 | 5 | 456.3 | 526 | 40 | 40 | 46.5 | 34 |
Usual care before the study
Recruitment and individuals reached: intervention
Recruitment of units and nursing staff
Nursing staff reached in the intervention
Phase | Nursing home | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
E29 | E79 | E89 | E75 | E82 | E50 | |||||||
N [MOD] | N [MOD] | N [MOD] | N [MOD] | N [MOD] | N [MOD] | |||||||
1st in-service training in WELCOME-IdA | 19 [6] | 22 [8] | 15 [3] | 9 [5] | 5 [3] | n/a | ||||||
2nd In-service training in WELCOME-IdA | 17 [6] | 25 [9] | 16 [5] | 11 [5] | 6 [4] | n/a | ||||||
Unit 1 | Unit 2 | Unit 1 | Unit 2 | Unit 1 | Unit 2 | Unit 1 | Unit 2 | Unit 1 | Unit 2 | Unit 1 | Unit 2 | |
N [MOD] | N [MOD] | N [MOD] | N [MOD] | N [MOD] | N [MOD] | N [MOD] | N [MOD] | N [MOD] | N [MOD] | N [MOD] | ||
1st WELCOME-IdA on-the-job training | 8 [5] | 11 [6] | 14[4] | MD | 6 [2] | 5 [2] | 9 [5] | 8 [4] | 4 [3] | n/a | n/a | |
2nd WELCOME-IdA on-the-job training | 10 [6] | 12 [6] | 16 [6] | MD | n/a | 10 [4] | 6 [3] | 9 [4] | 6 [1] | n/a | n/a | |
3rd WELCOME-IdA on-the-job training | 11 [6] | 11 [6] | 9 [5] | MD | – | 7 [4] | 7 [4] | 7 [4] | 4 [1] | n/a | n/a | |
4th WELCOME-IdA on-the-job training | 9 [6] | 10 [6] | 17 [4] | 8 [1] | n/a | n/a | 6 [4] | 6 [4] | 4 [1] | n/a | n/a | |
1st WELCOME-IdA off-the-job training | 15 [5] | 12 [5] | n/a | n/a | n/a | n/a | MD | n/a | n/a | n/a | n/a | |
2nd WELCOME-IdA off-the-job training | 15 [4] | 11 [5] | 10 [3] | 7 [3] | n/a | n/a | n/a | MD | n/a | n/a | n/a | |
3rd WELCOME-IdA off-the-job training | 19 [6] | 17 [6] | 10 [4] | 8 [2] | n/a | n/a | n/a | MD | MD | n/a | n/a | |
4th WELCOME-IdA off-the-job training | 14 [5] | 15 [5] | 12 [2] | 7 [1] | n/a | n/a | MD | n/a | n/a | n/a | n/a |