Implementing a wound care education programme for nursing staff working in long-term residential care facilities in Hong Kong : a realist evaluation

Abstract

With the advancement in medical sciences, people are living longer leading to a global trend of population aging. Older adults living in long-term residential care are at risk of the detrimental impact of aging and possible trauma. There are chances for wound development and delayed wound healing. However, little is known on the perceived needs of wound care training and its effectiveness. This study aims to design a wound care education programme for nursing staffs working in long-term residential care through elicitation and evaluate the context-mechanism–outcome configurations of the programme. The specific objectives are (1) to elicit the needs in wound care education for nursing staffs working in long-term residential care facilities, (2) to design a wound care education programme, (3) to examine the efficacy of the programme on self-efficacy and self-confidence in wound care; and (4) to evaluate what in the programme works for whom in what circumstances. An elicitation study including a systematic review and six focus group interviews of twenty-three nursing staffs working in long-term residential care in Hong Kong from November 2017 to January 2018 were conducted. Focus group interviews were transcribed verbatim with thematic analysis. Afterwards, a realist evaluation on wound care educational programme was conducted in twenty-two nursing staffs in two local residential care homes from December 2019 to January 2020. Qualitative individual interviews were transcribed verbatim with thematic content analysis performed. General linear model regression analysis was used to evaluate the efficacy in quantitative approach. Focus group study elicited positive attitude and subjective norm, but poor perceived behavioural control including self-efficacy and self-confidence in nursing staffs. A wound care educational programme was designed according to the elicited needs. After programme implementation, pre-test – post-test results yielded a significant increase in the participants’ self-efficacy (mean difference= +4.36, P<0.001) and self-confidence (mean difference= +3.77, P<0.014). Qualitative results found that the programme works in five circumstances. Firstly, it controlled professional awareness by refreshment and praising of positive attitude; secondly, the content, supplementary components and pedagogical approach promoted meaningful reasoning in wound care provision; thirdly, the supplementary components provided information in time-sensitive manner facilitated information processing in learning and evidence-based practice; fourthly, the collective activities during scenario-based workshop enhanced applicability of knowledge and mental rehearsal; lastly, strategies used to ensure organizational support foster collaboration. This study also revealed that the programme was more sustainable in the context where the resources, motivating factors, and teamwork were better established. Nursing staff working in long-term residential care facilities were found to have lack of organized training leading to substandard wound care to the older adult. With the input of the wound care education programme, relationship between context, mechanism and outcome were constructed on what in the programme work for whom in what circumstances. Future education of nursing staffs in long-term residential care should consider the causative mechanism for better outcome. Policies on balancing resources can minimize the contextual difference. The transferable mechanism can be used to frame post-licensing education programme in long-term residential care facilities.