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Feasibility, acceptability, and adherence of two educational programs for care staff concerning nursing home patients’ fecal incontinence: a pilot study preceding a cluster-randomized controlled trial

机译：护理人员关于疗养院患者粪便失禁的两项教育计划的可行性，可接受性和坚持性：一项在整群随机对照试验之前进行的先导研究

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Background Fecal incontinence has a high prevalence in the nursing home population which cannot be explained by co-morbidity or anatomic and physiological changes of aging alone. Our hypothesis is that fecal incontinence can be prevented, cured, or ameliorated by offering care staff knowledge of best practice. However, it is not clear which educational model is most effective. To assess the effect of two educational programs for care staff, we planned a three armed cluster-randomized controlled trial. There is a lack of research reporting effects of interventions targeting improved continence care processes in older patients. Thus, to improve the quality of the planned trial, we decided to carry out a pilot study to investigate the feasibility of the planned design, the interventions (educational programs) and the outcome measures, and to enable a power calculation. This paper reports the results from the pilot study. Methods Three nursing homes, representing each arm of the planned trial, were recruited. Criteria for assessing success of feasibility were pre-specified. Methods, outcome measures, acceptability, and adherence of the components of the intervention were evaluated by descriptive statistical analyses and qualitative content analysis of one focus group interview (n?=?7) and four individual interviews. Results The main study is feasible with one major and some minor modifications. Due to challenges with recruitment and indications supporting the assumption that a single intervention with one workshop is not sufficient as an implementation strategy, the main study will be reduced to two arms: a multifaceted education intervention and control. The components of the multifaceted intervention seemed to work well together and need only minor modification. Important barriers to consider were sub-optimal use of skill-mix, problems of communicating important assessments and care plans, and isolated nurses with an indistinct nurse identity. Conclusions Overall, the main study is feasible. The pedagogical approach needs to consider the identified barriers. Thus, it is essential to empower nurses in their professional role, to facilitate clinical reasoning and critical thinking among care staff, and to facilitate processes to enable care staff to find, report, and utilize information in the electronic patient record. Trial registration ClinicalTrials.gov: NCT01939821 webcite
机译：背景粪便失禁在疗养院人群中普遍存在，这不能通过并发疾病或仅是衰老的解剖和生理变化来解释。我们的假设是，通过向护理人员提供最佳实践知识，可以预防，治愈或改善大便失禁。但是，尚不清楚哪种教育模式最有效。为了评估针对护理人员的两项教育计划的效果，我们计划进行一项三项武装的集群随机对照试验。缺乏针对老年患者改善节制护理过程的干预措施效果的研究报告。因此，为了提高计划试验的质量，我们决定进行一项试点研究，以调查计划设计的可行性，干预措施（教育计划）和结果措施，并进行功效计算。本文报告了初步研究的结果。方法招募了三个疗养院，代表计划中的试验的每个部门。预先确定了可行性评估的标准。通过描述性统计分析和定性内容分析，对一次焦点小组访谈（n == 7）和四次个人访谈，评估了干预措施的方法，结果测量，可接受性和依从性。结果主要研究是可行的，只有一个主要的和一些小的修改。由于招募方面的挑战和迹象表明，只有一次讲习班与一次讲习班不足以作为实施战略的假设，因此主要研究将归结为两个方面：多方面的教育干预和控制。多方面干预措施的各个组成部分似乎可以很好地协同工作，只需要稍作修改即可。需要考虑的重要障碍包括：技能组合使用不佳，沟通重要评估和护理计划的问题以及护士身份模糊的孤立护士。结论总的来说，主要研究是可行的。教学方法需要考虑已确定的障碍。因此，至关重要的是要使护士能够发挥其专业作用，在护理人员中促进临床推理和批判性思维，并促进使护理人员能够查找，报告和利用电子病历中的信息的过程。试用注册ClinicalTrials.gov：NCT01939821网站

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