A study of intervention functions and policy categories in implementing a complex nursing intervention (PREDOCS) in Dutch hospitals; a phase four implementation study

Abstract

Background Reducing burden, complications and costs for frail patients undergoing cardiac surgery a nursing intervention called “PREvention Decline in Older Cardiac Surgery patients” (PREDOCS) was conceived. Goal is to prepare these 65 and older patients, before admission mentally and physically to reduce or prevent postoperative complications. Aim Is to gain insight in how policy categories (third ring) and intervention functions (second ring) of the Behaviour Change Wheel reflect in implementation of the PREDOCS and how supporting intervention functions and policies are used to reach desired behaviour of stakeholders. Method Mixed method study design with eight interviews, conducted using realist review method. Interviews were analysed, after transcription, using sensitizing concepts. Themes were derived from interviews and linked to the second and third ring of the Behaviour Change Wheel. Descriptive statistics on the PREDOCS scores to compare hospitals. Results From the data 7 themes were extracted, nursing ownership, training, support by management, support from medical staff, support by secretariat, plan of action and enthusiasm. Themes could be linked to all the interventions in the second ring and 5 out of 7 from the third ring. All the interventions were more or less explicitly used during the implementation, whereas the policies from the third ring were used more implicit. The statistical data was not available, what made comparison between the hospitals impossible. Conclusions and recommendations Nurses and senior nurses had trouble making a plan of action and the behaviour change wheel could help with development. Fundamental in making the implementation succeed is nursing ownership, with back up by management and one cardiac surgeon. Quantitative data was not available, therefore comparison between hospitals were impossible. This should be done when data comes available.