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Table 6 Enablers and barriers of implementation at the nursing home level

From: Implementation of a complex intervention to improve participation in older people with joint contractures living in nursing homes: a process evaluation of a cluster-randomised pilot trial

Categories Enablers Barriers
Personal factors • Social relationships (F)
 - Respect and social support of facilitators by the nursing team (F)
• Social relationships (F)
 - Therapists perceive PECAN as an interference in their responsibilities (F)
 - Conflicting opinions and challenges within the interprofessional team regarding the care of residents with joint contractures (F, T)
• Motives and motivation (F, SW, R)
 - Differing priorities of management and nursing team (F)
 - Poor motivation or little interest of the different stakeholders, i.e., nurses (F), physicians (F), therapists (F), social workers (SW) or residents (R)
 - Lack of interprofessional attitude among physicians (F)
 - Uncertainty and fear among relatives (e.g., additional costs, overburdening) (F)
Organisational factors • Clear commitment of the entire nursing home (F)
 - Active leadership to support changes (e.g., regularly occurring agreements and exchange, adoption of organisational tasks, approved time slots for meetings, provision of technical and medical aids) (F)
 - Open-mindedness to changes in the nursing team (e.g., review of residents’ care plans, implementation of measures to support participation, initiation of case conferences) (F)
 - Clear responsibilities within the interprofessional team (e.g., in collaboration with social workers, therapists and physicians) (F)
• Lack of impact on organisational conditions and routines (F, SW, T, R)
 - Unclear and unspecified responsibilities (F, SW)
 - Lack of interprofessional collaboration (e.g., little exchange, strict separation of working areas) (F, SW, T, R)
 - No established culture of contact and exchange between relatives and nursing staff (R)
 - No interprofessional case conferences (SW, T)
• Respect for the expertise of different healthcare professionals and relatives (F, SW, T, R)
 - Respect for involved healthcare professionals (F, SW, T, R)
 - Recognition of various expertise and resources (T, SW, R)
• Lack of time and staff competences (F, R, T)
 - Staff shortage and high workload for nurses (F, R, T) and therapists (F, T)
 - No time slots for unscheduled tasks (F)
 - Skills shortage in the nursing staff (F, R, T)
 - Language barriers of the nursing staff (R)
  1. Abbreviations: F facilitators, R relatives, T therapists, SW social workers
  2. Data base: Statements from the facilitators based on problem-centred interviews (9 participants) and one group discussion (4 participants). Statements from relatives (5 participants), therapists (4 participants) and social workers (4 participants) based on problem-centred interviews