Effectiveness of the ‘SELF-program’ on nurses' activity encouragement behavior and nursing home resident's ADL self-reliance; a cluster-randomized trial

Abstract

Background

Nurses play a crucial role in encouraging nursing home resident's activity and independent functioning. However, nurses often take over tasks unnecessarily, which can deprive resident's remaining abilities. The Function-Focused Care philosophy offers guidance for developing programs that support nurses to optimize activity and independence of older people. However, such programs developed internationally have demonstrated inconsistent effects. Lessons have been gathered to improve future programs, which led to the development of the ‘SELF-program’: a holistic, interactive and theory-based program that aims to improve activity encouragement behavior of nurses and indirectly to optimize self-reliance of nursing home residents.

Objective

The aim of this study was to examine the effectiveness of the SELF-program on nurses' activity encouragement behavior and nursing home residents' self-reliance in activities of daily living.

Method

The program's effectiveness was examined in a two-arm (SELF-program vs Care as Usual) cluster-randomized trial in Dutch nursing homes. Wards were recruited as units of intervention. The MAINtAIN questionnaire was used to assess the primary outcome: nurses' activity encouragement behavior regarding self-reliance in activities of daily living. The GARS-4 questionnaire was used to assess the secondary outcome: residents' self-reliance in activities of daily living. Measurements were taken at: 1) baseline, 2) three months after baseline, and 3) six months (for residents) and nine months (for nurses) after baseline. The acquired data was analyzed using mixed linear regression. Both adjusted and unadjusted analyses are reported.

Results

Twenty-eight nursing home wards, with 287 nurses and 241 residents participated in the study. A statistically significant treatment by time interaction effect was observed in nurses' activity encouragement behavior at three months (d = 0.53; p = .003; 95 % CI 1.88–8.02) and at nine months (d = 0.38; p = .02; 95 % CI 0.67–7.27). No statistically significant treatment by time interaction effects were observed in residents' self-reliance in activities of daily living. However, a trend was observed towards a less pronounced decrease in self-reliance in those residents allocated to wards that exposed nurses to the SELF-program, reflected by small to medium negative effect sizes at three months (d = − 0.25; p = .07; 95 % CI -2.21 – 0.09) and at six months (d = − 0.29; p = .07; 95 % CI -3.22 – 0.11).

Conclusion

The SELF-program was effective in improving nurses' activity encouragement behavior. The process evaluation conducted parallel to the trial could yield valuable lessons to further improve the SELF-program before widespread implementation.

Trial-registration

The study is registered in the Dutch Trial Register (NL9189), as of December 22 2020. Recruitment commenced in March 2021.