Deeltoets 1: Individuele kritische reflectie over de ontwikkeling van een complexe interventie
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1
, Introduction
The aim of this critical reflection is to carefully and systematically review the content, trustworthiness,
and relevance of the article1. Before implementing any changes in clinical practice, a thorough
evaluation of the regarding literature is a fundamental step. Hence, it is necessary to assess the
literature for its validity and generalizability to the specific patient community in the authors work
environment. It is important to prevent integration of biased or unreliable information into clinical
practice2. In this reflection, the author examined the article by Saal3 in which the development of a
complex intervention is presented. The abstract of the article is as follows:
Background Joints contractures are a common problem among elderly individuals residing in nursing
homes and affect the capacity to perform daily activities or engage in social interactions. The objective
of this study was to develop a complex intervention designed to enhance the participation of nursing
home residents with joint contractures.
Methods The study combined quantitative and qualitative methods. The approach included the re-
analysis of existing interview data through a graphical modeling approach, conducting group
discussions with nursing home residents, systematic review of intervention studies and organizing a
two-day workshop with experts in geriatrics, nursing, and rehabilitation, as well as holding a group
discussion with professionals working in nursing homes. For theoretical development of the
intervention, the International Classification of Functioning, Disability and Health (ICF) model was
used. Moreover, the development process adhered to the Framework set forth by the UK Medical
Research Council (MRC).
Results Limitations in the use of transportation, indoor mobility, memory functions and the use of
hands and arms as key areas of attention for the intervention, were identified by graphic modelling.
The group discussion with 33 nursing home residents resulted into insights about functioning and
disability according the IFC model domains body functions, body structures, activities and
participation, environmental factors, and personal factors. 17 studies were included in the systematic
review. However, the findings did not provide any supporting evidence for the effectiveness of an
intervention. The two-day expert workshop yielded a range of potential elements for an intervention as
well as strategies for its implementation. The feasibility and potential barriers of the concept
intervention and implementation were verified during the group discussion with professionals in
nursing homes. At last, the final version of the intervention protocol consisted of Participation Enabling
Care in Nursing (PECAN). The intervention has been implemented during a one-day workshop for
nurses. These nurses were nominated as key-users for the intervention in the nursing homes to offer
education for their colleagues.
Conclusion the PECAN intervention is now prepared for a pilot study to assess the effectiveness and
feasibility. During this pilot study, a process evaluation will be conducted to pinpoint the crucial
components of the intervention. While originally designed for nursing home residents with joint
contractures, there is a potential for residents at risk developing joint contracture to also benefit from
the PECAN intervention. This could be explored in a future implementation study.
2
….
1
, Introduction
The aim of this critical reflection is to carefully and systematically review the content, trustworthiness,
and relevance of the article1. Before implementing any changes in clinical practice, a thorough
evaluation of the regarding literature is a fundamental step. Hence, it is necessary to assess the
literature for its validity and generalizability to the specific patient community in the authors work
environment. It is important to prevent integration of biased or unreliable information into clinical
practice2. In this reflection, the author examined the article by Saal3 in which the development of a
complex intervention is presented. The abstract of the article is as follows:
Background Joints contractures are a common problem among elderly individuals residing in nursing
homes and affect the capacity to perform daily activities or engage in social interactions. The objective
of this study was to develop a complex intervention designed to enhance the participation of nursing
home residents with joint contractures.
Methods The study combined quantitative and qualitative methods. The approach included the re-
analysis of existing interview data through a graphical modeling approach, conducting group
discussions with nursing home residents, systematic review of intervention studies and organizing a
two-day workshop with experts in geriatrics, nursing, and rehabilitation, as well as holding a group
discussion with professionals working in nursing homes. For theoretical development of the
intervention, the International Classification of Functioning, Disability and Health (ICF) model was
used. Moreover, the development process adhered to the Framework set forth by the UK Medical
Research Council (MRC).
Results Limitations in the use of transportation, indoor mobility, memory functions and the use of
hands and arms as key areas of attention for the intervention, were identified by graphic modelling.
The group discussion with 33 nursing home residents resulted into insights about functioning and
disability according the IFC model domains body functions, body structures, activities and
participation, environmental factors, and personal factors. 17 studies were included in the systematic
review. However, the findings did not provide any supporting evidence for the effectiveness of an
intervention. The two-day expert workshop yielded a range of potential elements for an intervention as
well as strategies for its implementation. The feasibility and potential barriers of the concept
intervention and implementation were verified during the group discussion with professionals in
nursing homes. At last, the final version of the intervention protocol consisted of Participation Enabling
Care in Nursing (PECAN). The intervention has been implemented during a one-day workshop for
nurses. These nurses were nominated as key-users for the intervention in the nursing homes to offer
education for their colleagues.
Conclusion the PECAN intervention is now prepared for a pilot study to assess the effectiveness and
feasibility. During this pilot study, a process evaluation will be conducted to pinpoint the crucial
components of the intervention. While originally designed for nursing home residents with joint
contractures, there is a potential for residents at risk developing joint contracture to also benefit from
the PECAN intervention. This could be explored in a future implementation study.
2
