Implementation and preliminary testing of a theory-guided nursing discharge teaching intervention for adult inpatients aged 50 and over with multimorbidity: a pragmatic feasibility study protocol

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Abstract

Background

Discharge teaching by nurses during hospitalization is essential to provide multimorbid inpatients with the knowledge and skills to self-manage their health conditions. However, available disease-specific teaching guidelines do not address the cumulative complexity of multiple chronic diseases that occur with greater frequency in older adults. Therefore, there is a need for a discharge teaching intervention which uses concepts that specifically address the needs of these patients, such as considering their level of activation (i.e. knowledge, skills and confidence to self-manage their health) and the burden of multimorbid disease. The objectives of this pragmatic study will be to (1) test the feasibility of implementing a nursing discharge teaching intervention and (2) conduct a preliminary test of this novel discharge teaching intervention with adult inpatients age 50 or greater who have multiple comorbid conditions.

Methods

This study uses a two-group pre-posttest design. Participants are drawn from medical units in three hospitals in the French-speaking part of Switzerland. The implementation of the intervention will be facilitated by implementation strategies from the Theoretical Domains Framework and the Behavior Change Wheel and will target change in nurses’ teaching behaviours. Implementation outcomes will include measures of feasibility of the implementation strategies and the intervention process. Participants in the intervention group will receive tailored discharge teaching by trained teaching nurses. Patient outcomes will inform the preliminary testing of the intervention and will be measured with validated questionnaires assessing patients’ activation level, health confidence, perceived readiness for discharge, experience with the discharge process and rate of and time to readmission.

Discussion

The study takes a pragmatic approach to examining the feasibility of implementing the discharge teaching intervention to contribute to the knowledge development within the context of the real-world practice setting. Results will provide the foundation for clinical trials to build evidence for widespread adoption of this intervention.

Trial registration

The trial is registered at ClinicalTrials.gov (ID: NCT04253665) on the 30 of January 2020 and has been approved by the Cantonal Ethics Committee Vaud in Switzerland (2020-00141).

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-021-00812-4.

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Most cited references 63

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The behaviour change wheel: A new method for characterising and designing behaviour change interventions

Susan Michie, Maartje M. van Stralen, Robert H. West (2012)

Background Improving the design and implementation of evidence-based practice depends on successful behaviour change interventions. This requires an appropriate method for characterising interventions and linking them to an analysis of the targeted behaviour. There exists a plethora of frameworks of behaviour change interventions, but it is not clear how well they serve this purpose. This paper evaluates these frameworks, and develops and evaluates a new framework aimed at overcoming their limitations. Methods A systematic search of electronic databases and consultation with behaviour change experts were used to identify frameworks of behaviour change interventions. These were evaluated according to three criteria: comprehensiveness, coherence, and a clear link to an overarching model of behaviour. A new framework was developed to meet these criteria. The reliability with which it could be applied was examined in two domains of behaviour change: tobacco control and obesity. Results Nineteen frameworks were identified covering nine intervention functions and seven policy categories that could enable those interventions. None of the frameworks reviewed covered the full range of intervention functions or policies, and only a minority met the criteria of coherence or linkage to a model of behaviour. At the centre of a proposed new framework is a 'behaviour system' involving three essential conditions: capability, opportunity, and motivation (what we term the 'COM-B system'). This forms the hub of a 'behaviour change wheel' (BCW) around which are positioned the nine intervention functions aimed at addressing deficits in one or more of these conditions; around this are placed seven categories of policy that could enable those interventions to occur. The BCW was used reliably to characterise interventions within the English Department of Health's 2010 tobacco control strategy and the National Institute of Health and Clinical Excellence's guidance on reducing obesity. Conclusions Interventions and policies to change behaviour can be usefully characterised by means of a BCW comprising: a 'behaviour system' at the hub, encircled by intervention functions and then by policy categories. Research is needed to establish how far the BCW can lead to more efficient design of effective interventions.

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Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness.

U.H. Graneheim, B Lundman (2004)

Qualitative content analysis as described in published literature shows conflicting opinions and unsolved issues regarding meaning and use of concepts, procedures and interpretation. This paper provides an overview of important concepts (manifest and latent content, unit of analysis, meaning unit, condensation, abstraction, content area, code, category and theme) related to qualitative content analysis; illustrates the use of concepts related to the research procedure; and proposes measures to achieve trustworthiness (credibility, dependability and transferability) throughout the steps of the research procedure. Interpretation in qualitative content analysis is discussed in light of Watzlawick et al.'s [Pragmatics of Human Communication. A Study of Interactional Patterns, Pathologies and Paradoxes. W.W. Norton & Company, New York, London] theory of communication.

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SPIRIT 2013 statement: defining standard protocol items for clinical trials.

An-Wen Chan, Jennifer M Tetzlaff, Douglas G. Altman … (2013)

The protocol of a clinical trial serves as the foundation for study planning, conduct, reporting, and appraisal. However, trial protocols and existing protocol guidelines vary greatly in content and quality. This article describes the systematic development and scope of SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013, a guideline for the minimum content of a clinical trial protocol.The 33-item SPIRIT checklist applies to protocols for all clinical trials and focuses on content rather than format. The checklist recommends a full description of what is planned; it does not prescribe how to design or conduct a trial. By providing guidance for key content, the SPIRIT recommendations aim to facilitate the drafting of high-quality protocols. Adherence to SPIRIT would also enhance the transparency and completeness of trial protocols for the benefit of investigators, trial participants, patients, sponsors, funders, research ethics committees or institutional review boards, peer reviewers, journals, trial registries, policymakers, regulators, and other key stakeholders.

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Author and article information

Contributors

Joanie Pellet:

ORCID: https://orcid.org/0000-0001-9511-3355

joanie.pellet@chuv.ch

Marianne Weiss:

ORCID: https://orcid.org/0000-0003-4217-9822

marianne.weiss@marquette.edu

Franziska Zúñiga:

ORCID: https://orcid.org/0000-0002-8844-4903

franziska.zuniga@unibas.ch

Cedric Mabire:

ORCID: https://orcid.org/0000-0003-2666-8300

cedric.mabire@chuv.ch

Journal

Journal ID (nlm-ta): Pilot Feasibility Stud

Journal ID (iso-abbrev): Pilot Feasibility Stud

Title: Pilot and Feasibility Studies

Publisher: BioMed Central (London )

ISSN (Electronic): 2055-5784

Publication date (Electronic): 17 March 2021

Publication date PMC-release: 17 March 2021

Publication date Collection: 2021

Volume: 7

Electronic Location Identifier: 71

Affiliations

[1 ]GRID grid.8515.9, ISNI 0000 0001 0423 4662, Institute of Higher Education and Research in Healthcare, , Lausanne University Hospital and University of Lausanne, ; Lausanne, Switzerland

[2 ]GRID grid.259670.f, ISNI 0000 0001 2369 3143, Marquette University College of Nursing, ; Milwaukee, WI USA

[3 ]GRID grid.6612.3, ISNI 0000 0004 1937 0642, Nursing Science, Department Public Health, Faculty of Medicine, , University of Basel, ; Basel, Switzerland

Author information

Joanie Pellet https://orcid.org/0000-0001-9511-3355

Marianne Weiss https://orcid.org/0000-0003-4217-9822

Franziska Zúñiga https://orcid.org/0000-0002-8844-4903

Cedric Mabire https://orcid.org/0000-0003-2666-8300

Article

Publisher ID: 812

DOI: 10.1186/s40814-021-00812-4

PMC ID: 7968193

PubMed ID: 33731212

SO-VID: 5d89b058-1322-4182-9884-3f0c9e0377a7

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 10 July 2020

Date accepted : 4 March 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100007214, Velux Stiftung;

Award ID: Project n°1386

Award Recipient : Cedric Mabire

Custom metadata

Keywords: discharge teaching,multimorbidity,hospitalization,patient activation,implementation science,nursing

Data availability:

Keywords: discharge teaching, multimorbidity, hospitalization, patient activation, implementation science, nursing

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Implementation and preliminary testing of a theory-guided nursing discharge teaching intervention for adult inpatients aged 50 and over with multimorbidity: a pragmatic feasibility study protocol

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Abstract

Background

Methods

Discussion

Trial registration

Supplementary Information

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Journal of Health Sciences

Most cited references 63

The behaviour change wheel: A new method for characterising and designing behaviour change interventions

Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness.

SPIRIT 2013 statement: defining standard protocol items for clinical trials.

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