File(s) under permanent embargo
Process evaluation of implementing Protected Mealtimes under clinical trial conditions
Aim
To evaluate the implementation of Protected Mealtimes and contrast the findings with implementation fidelity.
Background
Protected Mealtimes is a systems approach developed to address the issue of malnutrition in hospitalized patients. Previous studies have used a pre‐–post study design, with no high‐quality trials previously undertaken to measure the effect of the intervention.
Design
A prospective, stepped‐wedge cluster randomized controlled trial was undertaken October–November 2015. This process evaluation was conducted using qualitative and quantitative methods to explain discrepancies between expected and observed clinical trial outcomes.
Methods
Qualitative data were collected using focus groups with the healthcare team and contrasted with fidelity data. Quantitative data were collected using attendance lists, audits and observations and analysed descriptively. Concept‐driven coding was undertaken using a framework derived from studies citing the Theoretical Domains Framework.
Findings
Staff training in the trial protocol was viewed positively, however, not all staff attended. Staff were generally enthusiastic about Protected Mealtimes with many programme aspects successfully implemented. Limited staffing resources, particularly of nursing staff, hindered implementation. The presence of trial observers affected staff morale by increasing feelings of stress and anxiety.
Conclusion
Process data allowed challenges for the implementation of Protected Mealtimes under clinical trial conditions to be described. Given our inability to implement the trial protocol fully due to the complexity of the mealtime environment and the lack of efficacy on nutritional intake, alternative approaches should be considered to resolve the problem of hospital malnutrition.
To evaluate the implementation of Protected Mealtimes and contrast the findings with implementation fidelity.
Background
Protected Mealtimes is a systems approach developed to address the issue of malnutrition in hospitalized patients. Previous studies have used a pre‐–post study design, with no high‐quality trials previously undertaken to measure the effect of the intervention.
Design
A prospective, stepped‐wedge cluster randomized controlled trial was undertaken October–November 2015. This process evaluation was conducted using qualitative and quantitative methods to explain discrepancies between expected and observed clinical trial outcomes.
Methods
Qualitative data were collected using focus groups with the healthcare team and contrasted with fidelity data. Quantitative data were collected using attendance lists, audits and observations and analysed descriptively. Concept‐driven coding was undertaken using a framework derived from studies citing the Theoretical Domains Framework.
Findings
Staff training in the trial protocol was viewed positively, however, not all staff attended. Staff were generally enthusiastic about Protected Mealtimes with many programme aspects successfully implemented. Limited staffing resources, particularly of nursing staff, hindered implementation. The presence of trial observers affected staff morale by increasing feelings of stress and anxiety.
Conclusion
Process data allowed challenges for the implementation of Protected Mealtimes under clinical trial conditions to be described. Given our inability to implement the trial protocol fully due to the complexity of the mealtime environment and the lack of efficacy on nutritional intake, alternative approaches should be considered to resolve the problem of hospital malnutrition.
History
Journal
Journal of Advanced NursingVolume
74Issue
8Pagination
1955 - 1963Publisher
Wiley-Blackwell PublishingLocation
Chichester, Eng.Publisher DOI
ISSN
0309-2402eISSN
1365-2648Language
engPublication classification
C1 Refereed article in a scholarly journalCopyright notice
2018, John Wiley & SonsUsage metrics
Categories
No categories selectedKeywords
Licence
Exports
RefWorks
BibTeX
Ref. manager
Endnote
DataCite
NLM
DC