Title: Understanding the context for implementation of an Older Adult Nurse Practitioner into rural and remote aged care settings.
Authors: Alison Craswell (submitting author), Kaye Coates, Alison Mudge, Katharina Merolini, Janet Baker, and Marianne Wallis.
1. Issues/context/background
Translation of research into practice is difficult, with few roadmaps to assist in translating proven interventions into clinical practice, especially in aged care settings [1, 2]. Implementation teams must consider inner (e.g. local culture and personnel) and outer (e.g. accreditation mandates, workforce planning) contextual features to support and sustain an intervention [3-5]. We are evaluating the implementation of a Nurse Practitioner (NP) into residential aged care homes in rural and remote Queensland. As a first step, we evaluated the context pre-implementation.
2. Methodology
The iPARIHS framework guided the context evaluation [6]. Data included Alberta Context Tool for long-term care survey [7], staff interviews, and review of resident/family evaluations. Data were mapped to i-PARIHS domains.
3. Results
An organisational culture of support (Domain: Inner Setting, Culture) saw all levels of staff expressing positivity for leadership, local culture and social connections. Staffing and time to fulfil a role (Domain: Inner Setting, Absorptive capacity) were challenging for all sites.
Rural and remote aged care facilities are often challenged integrating with their local healthcare environment (Domain: Outer Setting, Environmental (In)stability). For some sites this environment was stable and supportive ‘like a family’ while for others, retirement of local medical practitioners (GP), locum GPs and local hospitals unable to see unwell residents, contributed to instability.
5. Conclusions
Understanding the unique context of rural and remote aged care settings will support targeted implementation strategies and understand implementation success or failure as this complex intervention progresses
6. Implications
Thorough context evaluation may help compare success of this initiative with other sites, nationally and internationally.
References
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2. Titler, M., Methods in translation science. Worldviews on evidence-based nursing, 2004. 1(1): p. 38-48.
3. Bradley, E., et al., Translating research into clinical practice: making change happen. Journal of the American Geriatrics Society, 2004. 52(11): p. 1875-1882.
4. Naylor, M., et al., Translating research into practice: transitional care for older adults. Journal of Evaluation in Clinical Practice, 2009. 15(6): p. 1164-1170.
5. SteelFisher, G.K., et al., Sustaining clinical programs during difficult economic times: a case series from the Hospital Elder Life Program. J Am Geriatr Soc, 2011. 59(10): p. 1873-82.
6. Harvey, G., & Kitson, A. (2016). PARIHS revisited: from heuristic to integrated framework for the successful implementation of knowledge into practice. Implement Sci, 11, 33. doi:10.1186/s13012-016-0398-2
7. Estabrooks, C. A., Squires, J. E., Hayduk, L. A., Cummings, G. G., & Norton, P. G. (2011). Advancing the argument for validity of the Alberta Context Tool with healthcare aides in residential long-term care. BMC Med Res Methodol, 11, 107. doi:10.1186/1471-2288-11-107