Failed implementation of a nursing intervention to support family caregivers: An evaluation study using Normalization
Yvonne N Becqué1,2, Judith A C Rietjens2,3, Agnes van der Heide2
1Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.
Journal of Advanced Nursing
|June 17, 2024
Summary
Implementing the Carer Support Needs Assessment Tool for family caregivers in end-of-life care faced challenges. Organizational factors and the research context hindered its integration, despite its potential to improve nurse competence.
Area of Science:
- Healthcare Implementation Science
- End-of-Life Care Research
- Nursing Intervention Studies
Background:
- The Carer Support Needs Assessment Tool (CSNAT) intervention aimed to support family caregivers during end-of-life care.
- A previous trial experienced low participant numbers, necessitating an evaluation of implementation failures.
Purpose of the Study:
- To evaluate the failed implementation of the CSNAT intervention for family caregivers in end-of-life care.
- To identify factors hindering and promoting the normalization of the intervention within a trial context.
- To learn lessons for future complex care intervention implementations.
Main Methods:
- An evaluation study using retrospective data collection from interviews, questionnaires, emails, and conversation notes.
- Thematic analysis guided by Normalization Process Theory (NPT) constructs: coherence, cognitive participation, collective action, and reflexive monitoring.
Main Results:
- Nurses recognized the CSNAT's potential for competence but lacked clarity on its distinction from usual practice (coherence).
- Nurse champions facilitated a community of practice, though staff turnover and shortages posed sustainability challenges (cognitive participation).
- Training enhanced nurses' ability to support caregivers, but patient-focused care and high workloads complicated implementation (collective action).
- Positive nurse experiences were motivating, yet the research context created hesitancy in recruiting participants due to perceived burden (reflexive monitoring).
Conclusions:
- The CSNAT intervention shows potential for tailored support to family caregivers but was not optimally integrated into practice.
- Contextual factors, including a patient-focused approach and the research environment, impeded the intervention's normalization.
- Future implementations require careful assessment of contextual factors influencing complex care interventions.
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