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      Verstetigung von Implementierungsprozessen in der stationären Langzeitpflege : Nachhaltigkeit des Expertenstandards Beziehungsgestaltung in der Pflege von Menschen mit Demenz Translated title: Continuation of implementation processes in residential long-term care : Sustainability of the expert standard “Relationship management in the care of people with dementia”

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          Abstract

          Hintergrund

          Pflegeeinrichtungen stehen aufgrund von Evidenzbasierungsforderungen vor großen Herausforderungen. Sie sind aufgefordert, neue Interventionen wie Expertenstandards einzuführen und Alltagsroutinen an neue Erkenntnisse anzupassen. Wenn aber fortlaufend neue Interventionen in den Einrichtungen implementiert werden, ist deren Nachhaltigkeit fraglich.

          Ziel der Arbeit

          Ziel war es, zu eruieren, wie nachhaltig der Expertenstandard Beziehungsgestaltung in der Pflege von Menschen mit Demenz in Einrichtungen der stationären Langzeitpflege implementiert ist.

          Material und Methoden

          Es wurden qualitative, leitfadengestützte Interviews mit Personen aus der stationären Langzeitpflege, orientiert am Vorgehen des problemzentrierten Interviews, geführt. Die Befragten waren an der modellhaften Implementierung des Expertenstandards Beziehungsgestaltung in der Pflege von Menschen mit Demenz beteiligt. Die Daten wurden anschließend mithilfe der qualitativen Inhaltsanalyse ausgewertet.

          Ergebnisse

          Die Befragten schätzen die nachhaltige Umsetzung unterschiedlich ein. Einige bewerten die Nachhaltigkeit des Expertenstandards in ihrer Einrichtung als gelungen, andere wiederum sehen Verbesserungspotenzial. Nach Auffassung der Teilnehmenden wird die Verstetigung von Implementierungsprozessen durch verschiedene Faktoren beeinflusst. Diese betreffen die Einrichtung, den externen Kontext, die Intervention, den Implementierungsprozess und die Personen, die an der Implementierung beteiligt sind.

          Diskussion

          Auf Basis der identifizierten Faktoren lassen sich zentrale Bedarfe für die Pflegepraxis, für die Wissenschaft und Forschung sowie Politik und Gesetzgebung ableiten, damit die Nachhaltigkeit von Expertenstandards und weiteren evidenzbasierten Interventionen gewährleistet und ggf. optimiert wird.

          Translated abstract

          Background

          Nursing institutions are facing many challenges due to evidence-based requirements. For example, they are required to introduce new interventions such as expert standards and thus adapt routine practices to new findings; however, if new interventions are continuously implemented in the facilities their sustainability is questionable.

          Objective

          The aim was to find out how sustainably the expert standard “Relationship management in the care of people with dementia” is implemented in residential long-term care institutions.

          Material and methods

          Qualitative, guideline-based interviews were conducted with persons from residential long-term care, oriented to the procedure of the problem-centered interview. The interviewees were involved in the model implementation of the expert standard “Relationship management in the care of people with dementia”’. The data were then analyzed using qualitative content analysis.

          Results

          The participants assessed the sustainable implementation in different ways. Some rated the sustainability of the expert standard in their institution as successful, while others see potential for improvement. According to the participants, the sustainability of continuation of implementation processes is influenced by various factors. These relate to the institution, the external context, the intervention, the implementation process, and the people involved in the implementation.

          Conclusion

          On the basis of the factors identified, key needs can be derived for nursing practice, for science and research as well as for politics and legislation, so that the sustainability of expert standards and other evidence-based interventions can be ensured and, if necessary, optimized.

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          Most cited references21

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          Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

          Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. Conclusion The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.
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            Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda

            An unresolved issue in the field of implementation research is how to conceptualize and evaluate successful implementation. This paper advances the concept of “implementation outcomes” distinct from service system and clinical treatment outcomes. This paper proposes a heuristic, working “taxonomy” of eight conceptually distinct implementation outcomes—acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability—along with their nominal definitions. We propose a two-pronged agenda for research on implementation outcomes. Conceptualizing and measuring implementation outcomes will advance understanding of implementation processes, enhance efficiency in implementation research, and pave the way for studies of the comparative effectiveness of implementation strategies.
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              The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research

              Background The introduction of evidence-based programs and practices into healthcare settings has been the subject of an increasing amount of research in recent years. While a number of studies have examined initial implementation efforts, less research has been conducted to determine what happens beyond that point. There is increasing recognition that the extent to which new programs are sustained is influenced by many different factors and that more needs to be known about just what these factors are and how they interact. To understand the current state of the research literature on sustainability, our team took stock of what is currently known in this area and identified areas in which further research would be particularly helpful. This paper reviews the methods that have been used, the types of outcomes that have been measured and reported, findings from studies that reported long-term implementation outcomes, and factors that have been identified as potential influences on the sustained use of new practices, programs, or interventions. We conclude with recommendations and considerations for future research. Methods Two coders identified 125 studies on sustainability that met eligibility criteria. An initial coding scheme was developed based on constructs identified in previous literature on implementation. Additional codes were generated deductively. Related constructs among factors were identified by consensus and collapsed under the general categories. Studies that described the extent to which programs or innovations were sustained were also categorized and summarized. Results Although "sustainability" was the term most commonly used in the literature to refer to what happened after initial implementation, not all the studies that were reviewed actually presented working definitions of the term. Most study designs were retrospective and naturalistic. Approximately half of the studies relied on self-reports to assess sustainability or elements that influence sustainability. Approximately half employed quantitative methodologies, and the remainder employed qualitative or mixed methodologies. Few studies that investigated sustainability outcomes employed rigorous methods of evaluation (e.g., objective evaluation, judgement of implementation quality or fidelity). Among those that did, a small number reported full sustainment or high fidelity. Very little research has examined the extent, nature, or impact of adaptations to the interventions or programs once implemented. Influences on sustainability included organizational context, capacity, processes, and factors related to the new program or practice themselves. Conclusions Clearer definitions and research that is guided by the conceptual literature on sustainability are critical to the development of the research in the area. Further efforts to characterize the phenomenon and the factors that influence it will enhance the quality of future research. Careful consideration must also be given to interactions among influences at multiple levels, as well as issues such as fidelity, modification, and changes in implementation over time. While prospective and experimental designs are needed, there is also an important role for qualitative research in efforts to understand the phenomenon, refine hypotheses, and develop strategies to promote sustainment.
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                Author and article information

                Contributors
                Carolin.Mirbeth@ku.de
                Journal
                Z Gerontol Geriatr
                Z Gerontol Geriatr
                Zeitschrift Fur Gerontologie Und Geriatrie
                Springer Medizin (Heidelberg )
                0948-6704
                1435-1269
                21 December 2023
                21 December 2023
                2024
                : 57
                : 1
                : 21-26
                Affiliations
                Fakultät für Soziale Arbeit, Bereich Pflegewissenschaft, Katholische Universität Eichstätt-Ingolstadt, ( https://ror.org/00mx91s63) Kapuzinergasse 2, 85072 Eichstätt, Deutschland
                Article
                2266
                10.1007/s00391-023-02266-0
                10827942
                38127135
                c8f6989a-2c98-424d-a056-1ccce7b35ce3
                © The Author(s) 2023

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                History
                : 31 August 2023
                : 27 November 2023
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                © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2024

                qualität der gesundheitsversorgung,expertenstandard,implementierungswissenschaft,programmevaluation,evidenzbasierte pflege,quality of health care,practice guideline,implementation science,program evaluation,evidence-based nursing

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