Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-25T16:29:15.842Z Has data issue: false hasContentIssue false
  • English
  • Français

Specific components of a complex depression care program can affect staff outcomes differently: post-hoc analyses of a stepped-wedge cluster-randomized trial in nursing homes

Published online by Cambridge University Press:  17 January 2020

Ruslan Leontjevas ,
Linda Hooijschuur ,
Martin Smalbrugge ,
Raymond T.C.M. Koopmans  and
Debby L. Gerritsen
Ruslan Leontjevas*
Affiliation:
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands Faculty of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, The Netherlands Radboudumc Alzheimer Center, Nijmegen, The Netherlands
Linda Hooijschuur
Affiliation:
Stichting Humanitas, Rotterdam, The Netherlands
Martin Smalbrugge
Affiliation:
Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centre, Amsterdam, The Netherlands
Raymond T.C.M. Koopmans
Affiliation:
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands Radboudumc Alzheimer Center, Nijmegen, The Netherlands Joachim en Anna, Centre for Specialized Geriatric Care, Nijmegen, The Netherlands
Debby L. Gerritsen
Affiliation:
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands Radboudumc Alzheimer Center, Nijmegen, The Netherlands
*
Correspondence should be addressed to: Ruslan Leontjevas, School of Psychology, Open University of the Netherlands, P.O. Box 2960, 6401 DL Heerlen, The Netherlands. Phone +31 45 576 2504. E-mail: roeslan.leontjevas@ou.nl.
Get access

Abstract

Objective:

The Act in case of Depression program showed effects on the quality of life and depression in nursing home (NH) residents. We aimed to explore the effects of this complex multidisciplinary program on job satisfaction, job demands, and autonomy in nursing home staff.

Design:

Four data points from a stepped-wedge cluster-randomized trial on patient outcomes were used for secondary analyses on staff outcomes.

Setting:

Sixteen dementia special care and 17 somatic care units in Dutch NHs.

Participants were 717 (90.1%) care staff or trainees, 34 (4.3%) paramedical staff, and 45 (5.7%) other staff members.

Intervention describes procedures for nursing staff, activity therapists, psychologists, and physicians. It contains evidence-based pathways for depression assessment, treatment, and monitoring treatment results.

Results:

Mixed models for intention-to-treat analyses showed no significant changes in job demands, job satisfaction, or autonomy. Models corrected for the ratio of unit residents who received, when indicated, a specific program component revealed reduced job demands and improved job satisfaction and autonomy when treatment procedures were used. A better use of assessment procedures was associated with increased job demands, while conducting monitoring procedures was associated with increased job demands and decreased autonomy.

Conclusions:

Components of complex care programs may affect the staff outcomes in opposite directions and, taken together, produce a zero-sum or a statistically insignificant effect. While implementing treatment protocols affecting patients directly can also improve job outcomes such as satisfaction and autonomy and decrease job demands, it is possible that other procedures of complex programs may have unfavorable effects on job outcomes. It is important to account for specific components of complex interventions when evaluating intervention effects.

Keywords

carerslong-term carerandomized controlled trialaged carejob demandsautonomyjob satisfaction
Type
Original Research Article
Information
International Psychogeriatrics , Volume 32 , Issue 3: Issue Theme: Improving Healthcare in Long-Term Care and Nursing Homes , March 2020 , pp. 371 - 380
Copyright
© International Psychogeriatric Association 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ayalon, L., Arean, P. and Bornfeld, H. (2008). Correlates of knowledge and beliefs about depression among long-term care staff. International Journal of Geriatric Psychiatry, 23, 356–363. doi: 10.1002/gps.1884.CrossRefGoogle ScholarPubMed
Bates, D., Maechler, M., Bolker, B. and Walker, S. (2014). Fitting Linear Mixed-Effects Models using lme4. Journal of Statistical Software, 67, 1–48. doi: 10.18637/jss.v067.i01.Google Scholar
Broeck, A. V. d., Ferris, D. L., Chang, C.-H. and Rosen, C. C. (2016). A review of self-determination theory’s basic psychological needs at work. Journal of Management, 42, 1195–1229.CrossRefGoogle Scholar
Cohen, J. (1988). Statistical Power Analysis for the Behavioural Sciences. Hillsdale, NJ: Lawrence Earlbaum.Google Scholar
De Jonge, J. (1995). Job Autonomy, Well-being, and Health: A Study Among Dutch Health Care Workers. Maastricht: Rijksuniversiteit Limburg.Google Scholar
Dichter, M. N., Trutschel, D., Schwab, C. G. G., Haastert, B., Quasdorf, T. and Halek, M. (2017). Dementia care mapping in nursing homes: effects on caregiver attitudes, job satisfaction, and burnout. A quasi-experimental trial. International Psychogeriatrics, 29, 1993–2006. doi: 10.1017/S104161021700148X.CrossRefGoogle ScholarPubMed
Gerritsen, D. L., et al. (2011). Act In case of Depression: the evaluation of a care program to improve the detection and treatment of depression in nursing homes. Study protocol. BMC Psychiatry, 11, 91. doi: 10.1186/1471-244X-11-91.CrossRefGoogle ScholarPubMed
Hussey, M. A. and Hughes, J. P. (2007). Design and analysis of stepped wedge cluster randomized trials. Contemporary Clinical Trials, 28, 182–191. doi: 10.1016/j.cct.2006.05.007.CrossRefGoogle ScholarPubMed
Karsh, B., Booske, B. C. and Sainfort, F. (2005). Job and organizational determinants of nursing home employee commitment, job satisfaction and intent to turnover. Ergonomics, 48, 1260–1281. doi: 10.1080/00140130500197195.CrossRefGoogle ScholarPubMed
Koopmans, R., Pellegrom, M. and van der Geer, E. R. (2017). The Dutch move beyond the concept of nursing home physician specialists. Journal of the American Medical Directors Association, 18, 746–749. doi: 10.1016/j.jamda.2017.05.013.CrossRefGoogle ScholarPubMed
Landeweerd, J. A., Boumans, N. P. G. and Nissen, J. M. F. (1996). Arbeidsvoldoening bijverplegenden en verzorgenden. De Maastrichtse arbeidssatisfactieschaalvoor de gezondheidszorg. [Job satisfaction of nurses and CNAs. The Maastricht Work Satisfaction Scale for Healthcare]. In: Van Beek, C. C., Van Dorsten, T. G. and Stam, G. J. (Eds.), Handboek Verpleegkundige Innovatie. Houten: Bohn Stafleu.Google Scholar
Leontjevas, R. (2012). Act in case of Depression! Validation and Effectiveness of a Multidisciplinary Depression Care Program in Nursing Homes. Nijmegen: Radboud Universiteit Nijmegen.Google ScholarPubMed
Leontjevas, R., et al. (2013b). More insight into the concept of apathy: a multidisciplinary depression management program has different effects on depressive symptoms and apathy in nursing homes. International Psychogeriatrics, 25, 1941–1952. doi: 10.1017/S1041610213001440.CrossRefGoogle ScholarPubMed
Leontjevas, R., Gerritsen, D. L., Koopmans, R. T., Smalbrugge, M. and Vernooij-Dassen, M. J. (2012a). Process evaluation to explore internal and external validity of the “Act in Case of Depression” care program in nursing homes. Journal of the American Medical Directors Association, 13, 488 e481–488. doi: 10.1016/j.jamda.2012.03.006.CrossRefGoogle ScholarPubMed
Leontjevas, R., Gerritsen, D. L., Smalbrugge, M., Teerenstra, S., Vernooij-Dassen, M. J. and Koopmans, R. T. (2013a). A structural multidisciplinary approach to depression management in nursing-home residents: a multicentre, stepped-wedge cluster-randomised trial. Lancet, 381, 2255–2264. doi: 10.1016/S0140-6736(13)60590-5.CrossRefGoogle ScholarPubMed
Leontjevas, R., Gerritsen, D. L., Vernooij-Dassen, M. J., Teerenstra, S., Smalbrugge, M. and Koopmans, R. T. (2012b). Nijmegen observer-rated depression scale for detection of depression in nursing home residents. International Journal of Geriatric Psychiatry, 27, 1036–1044. doi: 10.1002/gps.2819.CrossRefGoogle ScholarPubMed
Low, L. F., et al. (2015). A systematic review of interventions to change staff care practices in order to improve resident outcomes in nursing homes. PLoS One, 10, e0140711. doi: 10.1371/journal.pone.0140711.CrossRefGoogle ScholarPubMed
McCabe, M. P., Mellor, D., Karantzas, G., Von Treuer, K., Davison, T. E. and O’Connor, D., (2017). Organizational factors related to the confidence of workers in working with residents with dementia or depression in aged care facilities. Aging & Mental Health, 21, 487–493. doi: 10.1080/13607863.2015.1118011.CrossRefGoogle ScholarPubMed
R Core Team (2015). A Language and Environment for Statistical Computing. Vienna: R Foundation for Statistical Computing. https://www.R-project.org.Google Scholar
Schaufeli, W. B. and Bakker, A. (2004). Job demands, job resources, and their relationship with burnout and engagement: a multi-sample study. Journal of Organizational Behavior, 25, 293–315. doi: 10.1002/job.248.CrossRefGoogle Scholar
Schmidt, S. G., Dichter, M. N., Bartholomeyczik, S. and Hasselhorn, H. M. (2014). The satisfaction with the quality of dementia care and the health, burnout and work ability of nurses: a longitudinal analysis of 50 German nursing homes. Geriatric Nursing, 35, 42–46. doi: 10.1016/j.gerinurse.2013.09.006.CrossRefGoogle ScholarPubMed
van Achterberg, T., Schoonhoven, L. and Grol, R. (2008). Nursing implementation science: how evidence-based nursing requires evidence-based implementation. Journal of Nursing Scholarship, 40, 302–310. doi: 10.1111/j.1547-5069.2008.00243.x.CrossRefGoogle ScholarPubMed
van Breukelen, G. J. P. and Candel, M. J. J. M. (2012). Calculating sample sizes for cluster randomized trials: we can keep it simple and efficient! Journal of Clinical Epidemiology, 65, 1212–1218. doi: 10.1016/j.jclinepi.2012.06.002.CrossRefGoogle ScholarPubMed
van Duinen-van den IJssel, J., et al. (2019). Effects on staff outcomes from an intervention for management of neuropsychiatric symptoms in residents of young-onset dementia care units: a cluster randomised controlled trial. International Journal of Nursing Studies, 96, 35–43. doi: 10.1016/j.jagp.2018.12.032.CrossRefGoogle ScholarPubMed
van Weert, J. C., van Dulmen, A. M., Spreeuwenberg, P. M., Ribbe, M. W. and Bensing, J. M. (2005). Effects of snoezelen, integrated in 24 h dementia care, on nurse-patient communication during morning care. Patient Education and Counseling, 58, 312–326. doi: 10.1016/j.pec.2004.07.013.CrossRefGoogle ScholarPubMed
Veldhoven, M. V., Prins, J., Laken, P. v. d. and Dijkstra, L. (2015). QEEW2.0; 42 Scales for Survey Research on Work, Well-being and Performance. Amsterdam: SKB.Google Scholar
Verbeke, G. and Molenberghs, G. (2000). Linear Mixed Models for Longitudinal Data. New York: Springer.Google Scholar
Verkaik, R., Francke, A. L., van Meijel, B., Spreeuwenberg, P. M., Ribbe, M. W. and Bensing, J. M. (2011a). The effects of a nursing guideline on depression in psychogeriatric nursing home residents with dementia. International Journal of Geriatric Psychiatry, 26, 723–732. doi: 10.1002/gps.2586.CrossRefGoogle ScholarPubMed
Verkaik, R., Francke, A. L., van Meijel, B., Spreeuwenberg, P. M., Ribbe, M. W. and Bensing, J. M. (2011b). The introduction of a nursing guideline on depression at psychogeriatric nursing home wards: effects on certified nurse assistants. International Journal of Nursing Studies, 48, 710–719. doi: 10.1016/j.ijnurstu.2010.06.007.CrossRefGoogle ScholarPubMed
Vernooij-Dasssen, M. J., et al. (2009). Dementia care and labour market: the role of job satisfaction. Aging & Mental Health, 13, 383–390.CrossRefGoogle ScholarPubMed
Williams, B., Perillo, S. and Brown, T. (2015). What are the factors of organisational culture in health care settings that act as barriers to the implementation of evidence-based practice? A scoping review. Nurse Education Today, 35, e34–41. doi: 10.1016/j.nedt.2014.11.012.CrossRefGoogle ScholarPubMed
Zangaro, G. A. and Soeken, K. L. (2007). A meta-analysis of studies of nurses’ job satisfaction. Research in Nursing & Health, 30, 445–458. doi: 10.1002/nur.20202.CrossRefGoogle ScholarPubMed
Zwijsen, S. A., Gerritsen, D. L., Eefsting, J. A., Smalbrugge, M., Hertogh, C. M. and Pot, A. M. (2015). Coming to grips with challenging behaviour: a cluster randomised controlled trial on the effects of a new care programme for challenging behaviour on burnout, job satisfaction and job demands of care staff on dementia special care units. International Journal of Nursing Studies, 52, 68–74. doi: 10.1016/j.ijnurstu.2014.10.003.CrossRefGoogle ScholarPubMed