Table 1 Implementation strategy actions and Implementation team
IMPLEMENTATION STRATEGY ACTIONS | |||||
What | When | Where | Length | Participants | Aim |
Preparatory leadership meetings 1st 2nd 3rd | Preparatory period | Research group premises | 8 h 3 h 3 h | NH director and/or director of nursing, INTERCARE nurse, project managera optional: home-based GP, financial director, data manager, unit managerb | -to assist with planning the implementation of core and peripheral components (see study protocol [7]) -to give support in the local tailoring and buy-in from co-workers -to work out the content of the new role and its added value for RNs -to identify barriers and facilitators -to answer questions |
Meeting with all NHs | Intervention period | Research group premises | 7 h | -to facilitate the exchange between NHs -to share the first results/insights of the exploratory study phase with contextual analysis -to discuss the implementation strategies -to discuss the necessary factors to obtain sustainable local implementation | |
Leadership and INTERCARE nurses' meetings | Transition period, Intervention period | NH | 2 h per meeting; number of meetings differed between NHs depending on the start of the Transition period | -to discuss the implementation of the intervention elements -to discuss the primary and secondary clinical outcomes, implementation outcomes, implementation strategies -to answer questions | |
INTERCARE nurses' training | Preparatory period, Baseline period, Transition period, Intervention period | Research group premises, e-learning | 390 h | INTERCARE nurse | -to prepare INTERCARE nurses to take over the clinical leadership roles and reduce the number of unplanned hospital admissions |
Phone calls | Transition period, Baseline period, Intervention period | NH | twice a month with INTERCARE nurse for one hour | INTERCARE nurse | -to discuss the implementation of intervention elements within the responsibility of the INTERCARE nurse -to support blended learning in the context of the INTERCARE curriculum (whole educational program) -to discuss challenges, barriers and facilitators in the role of INTERCARE nurse |
Internal training and information events | Preparatory period, Baseline period, Transition period, Intervention period | NH | Differ between NHs | Internal decision of NH | -to build a strong foundation for the implementation of the intervention elements -to establish realistic expectations and deliver cutting-edge practices -to empower teams through various educational activities -to coach about evidence-based instruments (STOP and WATCH, ISBAR, hospitalisation reflection tools) (see study protocol [7]) |
Administration and internal coordination | Preparatory period, Baseline period, Transition period, Intervention period | NH | Different between NHs | Internal decision of NH | -to ensure quality management -to regulate study coordination -to correct negative deviations and assure the accomplishment of plans -to indicate where coordination is still required and to make suitable changes |
IMPLEMENTATION TEAM | |||||
Group | Name | Description | |||
Research group | Implementation team (i.e., research team) | The research group included members from nursing, medicine, policy, and practice representing several institutions (university, university of applied sciences, cantonal public administration office, consulting firm, NH, hospital) and three language regions of Switzerland. The team developed and distributed educational materials (including guidelines, decision trees, handouts and PowerPoint presentations). All materials were made available on online learning platforms and/ or sent by email to support the implementation activities in the NHs. | |||
Study coordinator (part of the Implementation team) | Two-weekly phone calls with INTERCARE nurses to discuss individual challenges during the implementation process and to give feedback, support them in their personal development by critically reflecting on their own and others' behaviours and skills and discussing challenges, as well as to ensure effective knowledge transfer. | ||||
NH group | INTERCARE team | Study team within NH with the upper management members. The size and the other team members depend on NH organisation (INTERCARE nurse, physicians, unit leaders, etc.). | |||
INTERCARE nurse (part of the INTERCARE team) | This role is one of the six INTERCARE intervention elements. At the same time, she/he was key in introducing other intervention elements into practice. On the one hand, the INTERCARE nurse is a core element of the intervention. Each NH employed at least one INTERCARE nurse to take over a clinical leadership role. The role aimed to support the care workers in complex clinical situations, facilitate interprofessional collaboration, collect resident's data and advance clinical practice. On the other hand, in this role, she/he was responsible for implementing the core element evidence-based instruments in the NHs while distributing education materials, providing hands-on coaching, answering questions, and supporting staff in the use of instruments. In some NHs, depending on the study team structure, they were also responsible for implementing the “Advance Care Planning” intervention element. INTERCARE nurses followed a 390-h blended learning curriculum to prepare for their role. This included eight modules: Clinical leadership; Communication; Comprehensive geriatric assessment / Advance care planning; Geriatric syndromes; Chronic conditions; Acute symptoms; Medication management; Data-driven quality improvement. Learning methods include: E-learnings, readings, self-evaluations, reflections, face-to-face meetings, supervision and exchange among participants. Where more than one but less than two full-time INTERCARE nurses were necessary, the NHs decided whether they would split the role into two with smaller percentages and unequal or evenly shared responsibility. | ||||