The role of trained champions in sustaining and spreading nutrition care improvements in hospital: qualitative interviews following an implementation study.
malnutrition
Journal
BMJ nutrition, prevention & health
ISSN: 2516-5542
Titre abrégé: BMJ Nutr Prev Health
Pays: England
ID NLM: 101769223
Informations de publication
Date de publication:
2021
2021
Historique:
received:
05
04
2021
accepted:
13
09
2021
entrez:
14
1
2022
pubmed:
15
1
2022
medline:
15
1
2022
Statut:
epublish
Résumé
Many patients are already malnourished when admitted to hospital. Barriers and facilitators to nutrition care in hospital have been identified and successful interventions developed; however, few studies have explored how to sustain and spread improvements. The More-2-Eat phase 1 study involved five hospitals across Canada implementing nutrition care improvements, while phase 2 implemented a scalable model using trained champions, audit and feedback, a community of practice with external mentorship and an implementation toolkit in 10 hospitals (four continuing from phase 1). Process measures showed that screening and assessment from phase 1 were sustained for at least 4 years. The objective of this study was to help explain how these nutrition care improvements were sustained and spread by understanding the role of the trained champions, and to confirm and expand on themes identified in phase 1. Semistructured telephone interviews were conducted with champions from each phase 2 hospital and recordings transcribed verbatim. To explore the champion role, transcripts were deductively coded to the 3C model of Concept, Competence and Capacity. Phase 2 transcripts were also deductively coded to themes identified in phase 1 interviews and focus groups. Ten interviews (n=14 champions) were conducted. To sustain and spread nutrition care improvements, champions needed to understand the Trained local champions were required for implementation. By understanding key concepts, with appropriate and evolving competence and capacity, champions supported sustainability and spread of nutrition care improvements. Understanding the role of champions in supporting implementation, spread and sustainability of nutrition care improvements can help other hospitals when planning for and implementing these improvements. NCT02800304, NCT03391752.
Sections du résumé
BACKGROUND
BACKGROUND
Many patients are already malnourished when admitted to hospital. Barriers and facilitators to nutrition care in hospital have been identified and successful interventions developed; however, few studies have explored how to sustain and spread improvements. The More-2-Eat phase 1 study involved five hospitals across Canada implementing nutrition care improvements, while phase 2 implemented a scalable model using trained champions, audit and feedback, a community of practice with external mentorship and an implementation toolkit in 10 hospitals (four continuing from phase 1). Process measures showed that screening and assessment from phase 1 were sustained for at least 4 years. The objective of this study was to help explain how these nutrition care improvements were sustained and spread by understanding the role of the trained champions, and to confirm and expand on themes identified in phase 1.
METHODS
METHODS
Semistructured telephone interviews were conducted with champions from each phase 2 hospital and recordings transcribed verbatim. To explore the champion role, transcripts were deductively coded to the 3C model of Concept, Competence and Capacity. Phase 2 transcripts were also deductively coded to themes identified in phase 1 interviews and focus groups.
RESULTS
RESULTS
Ten interviews (n=14 champions) were conducted. To sustain and spread nutrition care improvements, champions needed to understand the
CONCLUSION
CONCLUSIONS
Trained local champions were required for implementation. By understanding key concepts, with appropriate and evolving competence and capacity, champions supported sustainability and spread of nutrition care improvements. Understanding the role of champions in supporting implementation, spread and sustainability of nutrition care improvements can help other hospitals when planning for and implementing these improvements.
TRIAL REGISTRATION NUMBER
BACKGROUND
NCT02800304, NCT03391752.
Identifiants
pubmed: 35028514
doi: 10.1136/bmjnph-2021-000281
pii: bmjnph-2021-000281
pmc: PMC8718867
doi:
Banques de données
ClinicalTrials.gov
['NCT02800304', 'NCT03391752']
Types de publication
Journal Article
Langues
eng
Pagination
435-446Informations de copyright
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
J Adv Nurs. 2016 Dec;72(12):3182-3194
pubmed: 27485574
Nutr J. 2015 Jun 19;14:63
pubmed: 26089037
Nutr Clin Pract. 2019 Dec;34(6):906-915
pubmed: 30997715
Implement Sci. 2019 Dec 17;14(1):105
pubmed: 31847920
Clin Nutr ESPEN. 2018 Apr;24:140-147
pubmed: 29576353
BMC Health Serv Res. 2017 Jul 19;17(1):498
pubmed: 28724373
Implement Sci. 2020 Aug 6;15(1):62
pubmed: 32762726
Healthcare (Basel). 2016 Oct 20;4(4):
pubmed: 27775604
Implement Sci. 2017 Sep 2;12(1):110
pubmed: 28865479
BMJ. 2019 May 10;365:l2068
pubmed: 31076440
SAGE Open Med. 2018 May 17;6:2050312118773261
pubmed: 29796266
J Hum Nutr Diet. 2014 Apr;27(2):192-202
pubmed: 24147893
BMC Health Serv Res. 2018 Dec 4;18(1):930
pubmed: 30509262
Health Rep. 2017 Sep 20;28(9):17-27
pubmed: 28930364
Nutr Clin Pract. 2019 Jun;34(3):459-474
pubmed: 30457167
Clin Nutr ESPEN. 2019 Apr;30:19-25
pubmed: 30904220
Healthcare (Basel). 2018 Jan 20;6(1):
pubmed: 29361696
Clin Nutr. 2017 Aug;36(4):958-967
pubmed: 27499391
Gerontol Geriatr Educ. 2011;32(2):164-81
pubmed: 21598149
Nutr J. 2018 Jan 05;17(1):2
pubmed: 29304866
Clin Nutr. 2021 Apr;40(4):2100-2108
pubmed: 33077271
J Acad Nutr Diet. 2018 Jan;118(1):101-109
pubmed: 29274640
J Health Organ Manag. 2019 Mar 18;33(1):78-92
pubmed: 30859913
Clin Nutr ESPEN. 2018 Oct;27:44-52
pubmed: 30144892
BMC Nutr. 2017 Jul 14;3:60
pubmed: 32153840
JPEN J Parenter Enteral Nutr. 2011 Jan;35(1):16-24
pubmed: 21224430
JPEN J Parenter Enteral Nutr. 2016 May;40(4):487-97
pubmed: 25623481
Appl Physiol Nutr Metab. 2018 Dec;43(12):1239-1246
pubmed: 29738268
Clin Nutr. 2019 Apr;38(2):897-905
pubmed: 29605573
BMC Health Serv Res. 2019 Nov 21;19(1):868
pubmed: 31752846
Implement Sci. 2009 Aug 07;4:50
pubmed: 19664226
Implement Res Pract. 2021 Jan 1;2:
pubmed: 34541541
JPEN J Parenter Enteral Nutr. 2021 May;45(4):670-684
pubmed: 33236411
Implement Sci Commun. 2021 Apr 1;2(1):35
pubmed: 33795027
Nurs Times. 2013 Oct 2-8;109(39):22-4
pubmed: 24303615
Milbank Q. 2004;82(4):581-629
pubmed: 15595944
Implement Sci. 2011 Apr 23;6:42
pubmed: 21513547
Cochrane Database Syst Rev. 2012 Jun 13;(6):CD000259
pubmed: 22696318
Clin Nutr ESPEN. 2018 Dec;28:74-79
pubmed: 30390896
JPEN J Parenter Enteral Nutr. 2017 Mar;41(3):384-391
pubmed: 27923890
J Nurs Care Qual. 2004 Oct-Dec;19(4):297-304
pubmed: 15535533
Implement Sci. 2020 Oct 1;15(1):87
pubmed: 32998750