Nurses in the Lead - Nursing Leadership and Autonomy in Function Focused Care in Hospital

Официальное название

Nurses in the Lead - Nursing Leadership and Autonomy in Function Focused Care in Hospital: a Prospective Before-after Study

Обзор

The goal of this prospective before-after study (observational) is to implement Function Focused Care in Hospital (FFCiH), paying specific attention to the role of nurses and how they can take the leadership and autonomy in the interprofessional collaboration regarding FFCiH. To reach this aim, the researchers defined two sub-objectives: 1\. to identify barriers and facilitators (determinants) for nursing autonomy and leadership and application FFCiH in the interprofessional collaboration on a surgical and internal medicine ward to design a tailored implementation strategy for FFCiH. 2. to evaluate the effectiveness of the implementation strategy on nursing leadership and the application of FFCiH. The investigators developed two work packages related to the two sub-objectives: identifying determinants and strategies for the successful application of FFCiH and nurse leadership, among others, by introducing nurse champions and evaluating their effect on the application of FFCiH. The primary endpoint is the level of application of FFCiH as reflected in adherence to and coverage of FFCiH in daily nursing care. The secondary endpoints are: 1) for nurses: the nurses' role development with regards to leadership and autonomy in the application of FFCiH by ward nurses and nurse champions, leadership competencies of ward nurses, and autonomy of ward nurses and 2) for patients: physical functioning and independency in mobility and ADL. Researchers will compare FFCiH with usual care to see if there are differences regarding the outcome measurements. The study population consists of nurses, physiotherapists, doctors, other member of the interprofessional team, hospitalized patients and their relatives. Intervention: FFCiH focuses on stimulating nurses to promote patients' self-reliance in daily functioning, encouraging the patients' engagement in daily activities and, helping patients to attain and maintain their highest level of function and increasing time spent in physical activity. FFCiH is a proven effective approach for promoting patients' physical functioning and mobility.

Подробное описание

The investigators will conduct a prospective before-after multicenter study, including a process evaluation, with a mixed methods approach in two university medical centers. In the preparation phase before the before-after study the tailored implementation strategy for FFCiH will be developed. Between the before and after phases of the study, the investigators will implement in two or three cyclic processes the FFCiH approach by strengthening nursing leadership and autonomy in the application of FFCiH in the interprofessional collaboration, using the predefined tailored implementation strategy.

Вмешательства

• Поведенческое Function Focused Care
  FFCiH is an effective nursing approach and focuses on stimulating nurses to promote patients' self-reliance in daily functioning, encouraging the patients' engagement in daily activities and helping patients to attain and maintain their highest level of function and to increase time spent in physical activity.

Первичные конечные точки

• Level of leadership using the Leadership Practices Inventory (LPI) - Nurses [Срок оценки: up to four weeks directly before implementation & up to four weeks directly after implementation]
• Level of autonomy - Nurses [Срок оценки: up to four weeks directly before implementation & up to four weeks directly after implementation]

Вторичные конечные точки (5)

• Adherence (fidelity) [Срок оценки: up to four weeks after implementation]
• Level of mobility - Patients [Срок оценки: <72 hours after hospital admission and at discharge (assessed up to 3 days)]
• Level of independence in Activities of Daily Livings - patients [Срок оценки: <72 hours after hospital admission and at discharge (assessed up to 3 days)]
• Level of coverage (reach) [Срок оценки: up to four weeks after implementation]
• Numbers of days stayed in the hospital - patients [Срок оценки: At discharge (assessed up to 14 days)]

Критерии участия

Nurses and student nurses (vocational nursing educational level (MBO)/ (bachelor nursing educational level (HBO)):

Критерии включения

\- All (student-)nurses working in the participating wards are expected to be involved in application of FFC and role development with regards to leadership and autonomy of nurses and therefore considered to be eligible for participation in the study.

Критерии исключения

\- No exclusion criteria were defined for nurses and student nurses.

Physiotherapists, doctors and other member of the interprofessional team;

Критерии включения

\- All professional groups that are part of the interprofessional team of the ward and who work in the participating wards are expected to collaborate with the nursing in their daily care and therefore considered to be eligible for participation in this study.

Критерии исключения

\- No exclusion criteria were defined for physiotherapists, doctors and other members of the interprofessional team.

Patients and informal caregivers:

Критерии включения

\- All patients admitted to the participating wards of the 2 hospitals receiving care either before or after the implementation of FFC and the patients informal caregiver as determined by the patient.

Критерии исключения

• A life-threatening situation or in a terminal phase upon admission (only applicable to patients)
• Not mastering the Dutch language;
• Not able to communicate adequately, based on a below threshold score on the MOCA or the FAST (only applicable to patients)
• A second hospitalization on one of the participating wards after being included in the study during the study period;
• An hospitalization < 48 hours

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Модель наблюдения

Другое

Центры проведения

Нидерланды · 3 центра

• Stichting Slingeland Ziekenhuis — Doetinchem
• Leiden University Medical Center — Leiden
• Erasmus MC — Rotterdam

Публикации

• Kok S, Schoonhoven L, Vernooij LM, Reitsma JB, Verstraten C, Metzelthin SF, Bleijenberg N, de Man-van Ginkel JM. The effectiveness of Function Focused Care among patients acutely admitted to hospital: A stepped wedge cluster trial. Int J Nurs Stud. 2024 Dec;160:104893. doi: 10.1016/j.ijnurstu.2024.104893. Epub 2024 Sep 4. PMID 39321557
• Kok S, de Man-van Ginkel JM, Verstraten C, Resnick B, Metzelthin SF, Bleijenberg N, Schoonhoven L. Function focused care in hospital: A mixed-method feasibility study. Int J Nurs Stud Adv. 2021 Sep 29;3:100045. doi: 10.1016/j.ijnsa.2021.100045. eCollection 2021 Nov. PMID 38746732

Идентификаторы

NCT: NCT06878820 · 134718 · 10040022230013

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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