Page 188 - Demo

Chapter 7186perspectives when making involuntary care decisions, which was the aim of NAF, was also tested. In contrast to the subjective positive evaluations of collaborating in the CoP on designing implementation plans, no statistical differences in implementation and awareness of clients%u2019 perspectives were found between care staff in organisations that participated in the CoP and organisations that implemented NAF as usual. Possible hindering factors influencing the outcomes of this part of the study as well as the sensitivity of study for detecting effects included Covid-19, illnesses, absences, and departures of care professionals. Another barrier that might have influenced the results of this research was the exclusive administration of questionnaires to care staff, rather than including intermediate disciplines responsible for further implementing the NAF to care teams. Because the implementation interventions designed in the CoP were not always directly targeted at care staff but often at intermediate disciplines, the effects of these implementation interventions might not have been fully captured. This could mean that the actual impact of the interventions designed within the CoP on the broader organisational implementation of the NAF might not have been detected. Regarding the second effort, the multi-method study described in Chapter 6 evaluated MDET adaptations made by four organisations and tested whether these adapted MDET versions were successful in reducing involuntary care in care homes (implementation groups), compared to care homes that did not implement MDET (control groups). The qualitative results showed that all four care organisations made major adaptations to the original MDET method. For example, two care organisations did not initiate an independent MDET expert team. In all care organisations, thoroughly discussing involuntary care with entire care teams was compromised because of time issues. Moreover, MDET coordinators did not check involuntary care recordings in care homes and had doubts whether these were regularly updated. With interrupted time-series analyses, changes in involuntary care recordings were tested over time. Results showed no significant differences in these recordings between care homes that implemented MDET and care homes providing care as usual. Furthermore, no significant differences in recordings were found before and after the start of MDET in the implementation groups.