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Nguyen N, Thalhammer R, Meyer G, Le L, Mansmann U, Vomhof M, Skudlik S, Beutner K, Müller M. Effectiveness of an individually tailored complex intervention to improve activities and participation in nursing home residents with joint contractures (JointConEval): a multicentre pragmatic cluster-randomised controlled trial. BMJ Open 2023; 13:e073363. [PMID: 37899149 PMCID: PMC10619003 DOI: 10.1136/bmjopen-2023-073363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 10/01/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE This study aims to examine the effects of the individually tailored complex intervention Participation Enabling Care in Nursing (PECAN) on activities and participation of residents with joint contractures. DESIGN Multicentre pragmatic cluster-randomised controlled trial. SETTING 35 nursing homes in Germany (August 2018-February 2020). PARTICIPANTS 562 nursing home residents aged ≥65 years with ≥1 major joint contracture (303 intervention group, 259 control group). INTERVENTIONS Nursing homes were randomised to PECAN (18 clusters) or optimised standard care (17 clusters) with researcher-concealed cluster allocation by facsimile. The intervention targeted impairments in activities and participation. Implementation included training and support for selected staff. Control group clusters received brief information. PRIMARY AND SECONDARY OUTCOME MEASURES The primary endpoint PaArticular Scales combined residents' activities and participation at 12 months. The secondary outcome comprised quality of life. Safety measures were falls, fall-related consequences and physical restraints. Residents, staff and researchers were unblinded. Data collection, data entry and statistical analysis were blinded. Primary analyses were intention-to-treat at cluster level and individual level using a generalised mixed-effect regression model and imputation of missing data. RESULTS Primary outcome analyses included 301 intervention group residents and 259 control group residents. The mean change on the Activities Scale was -1.47 points (SD 12.2) in the intervention group and 0.196 points (SD 12.5) in the control group and -3.87 points (SD 19.7) vs -3.18 points (SD 20.8) on the Participation Scale. The mean differences of changes between the groups were not statistically significant: Activities Scale: -1.72 (97.5% CI -6.05 to 2.61); Participation Scale: -1.24 (97.5% CI -7.02 to 4.45). We found no significant difference in the secondary outcome and no effects on safety measures. CONCLUSION The complex intervention did not improve the activities and participation of nursing home residents on the PaArticular Scales at 12 months. Current nursing conditions in Germany may hamper implementation. TRIAL REGISTRATION NUMBER DRKS00015185.
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Affiliation(s)
- Natalie Nguyen
- Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Regina Thalhammer
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany
| | - Gabriele Meyer
- Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Lien Le
- Faculty of Medicine, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilians University Munich, Munich, Germany
| | - Ulrich Mansmann
- Faculty of Medicine, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilians University Munich, Munich, Germany
| | - Markus Vomhof
- Faculty of Medicine, Centre for Health and Society, Institute for Health Services Research and Health Economics, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Stefanie Skudlik
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany
| | - Katrin Beutner
- Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Martin Müller
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany
- Medical Faculty Heidelberg, Department for Primary Care and Health Services Research, Nursing Science and Interprofessional Care, Heidelberg University, Heidelberg, Germany
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STOLT M, KOTTORP A, SUHONEN R. The use and quality of reporting of Rasch analysis in nursing research: a methodological scoping review. Int J Nurs Stud 2022; 132:104244. [DOI: 10.1016/j.ijnurstu.2022.104244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 11/24/2022]
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Chen YC, Lin KC, Chen CJ, Yeh SH, Pan AW, Chen HL, Wang CH. Psychometric validation of the Chinese version of the PaArticular Scales among elderly residents in long-term care facilities with joint contractures. BMC Geriatr 2021; 21:353. [PMID: 34107873 PMCID: PMC8190856 DOI: 10.1186/s12877-021-02297-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background Joint contractures, which affect activity, participation, and quality of life, are common complications of neurological conditions among elderly residents in long-term care facilities. This study examined the reliability and validity of the Chinese version of the PaArticular Scales in a population with joint contractures. Methods A cross-sectional study design was used. The sample included elderly residents older than 64 years with joint contractures in an important joint who had lived at one of 12 long-term care facilities in Taiwan for more than 6 months (N = 243). The Chinese version of the PaArticular Scales for joint contractures was generated from the English version through five stages: translation, review, back-translation, review by a panel of specialists, and a pretest. Test-retest reliability, internal consistency reliability, construct validity, and criterion validity were evaluated, and the results were compared with those for the World Health Organization Quality of Life scale and the World Health Organization Disability Assessment Schedule. Results The Chinese version of the PaArticular Scales had excellent reliability, with a Cronbach α coefficient of 0.975 (mean score, 28.98; standard deviation, 17.34). An exploratory factor analysis showed three factors and one factor with an eigenvalue > 1 that explained 75.176 and 62.83 % of the total variance in the Activity subscale and Participation subscale, respectively. The subscale-to-total scale correlation analysis showed Pearson correlation coefficients of 0.881 for the Activity subscale and 0.843 for the Participation subscale. Pearson’s product-moment correlation revealed that the correlation coefficient (r) between the Chinese version of the PaArticular Scales and the World Health Organization Disability Assessment Schedule was 0.770, whereas that for the World Health Organization Quality of Life scale was − 0.553; these values were interpreted as large coefficients. Conclusions The underlying theoretical model of the Chinese version of the PaArticular Scales functions well in Taiwan and has acceptable levels of reliability and validity. However, the Chinese version must be further tested for applicability and generalizability in future studies, preferably with a larger sample and in different clinical domains. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02297-5.
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Affiliation(s)
- Yi-Chang Chen
- School of Occupational Therapy, College of Medicine, National Taiwan University, F4, No. 17, Xuzhou Rd., Zhongzheng Dist., Taipei, Taiwan
| | - Keh-Chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, F4, No. 17, Xuzhou Rd., Zhongzheng Dist., Taipei, Taiwan. .,Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., Taipei, Taiwan.
| | - Chen-Jung Chen
- Department of Nursing, Mackay Medical College, 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., Taipei, Taiwan
| | - Shu-Hui Yeh
- Institute of Long-term Care, Mackay Medical College, Taipei, Taiwan
| | - Ay-Woan Pan
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University, Taipei, Taiwan
| | - Hao-Ling Chen
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University, Taipei, Taiwan
| | - Chih-Hung Wang
- Graduate Institute of Education, National Changhua University of Education, No. 1, Jin-De Road, Changhua City, Taiwan
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Klingshirn H, Müller M, Beutner K, Hirt J, Strobl R, Grill E, Meyer G, Saal S. Implementation of a complex intervention to improve participation in older people with joint contractures living in nursing homes: a process evaluation of a cluster-randomised pilot trial. BMC Geriatr 2020; 20:270. [PMID: 32758147 PMCID: PMC7405353 DOI: 10.1186/s12877-020-01655-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 07/15/2020] [Indexed: 11/18/2022] Open
Abstract
Background Joint contractures in frail older people are associated with serious restrictions in participation. We developed the Participation Enabling CAre in Nursing (PECAN) intervention, a complex intervention to enable nurses to promote participation in nursing home residents with joint contractures. The aim of this study was to examine the feasibility of the implementation strategy and to identify enablers and barriers for a successful implementation. Methods The implementation of PECAN was investigated in a 6-month pilot cluster-randomised controlled trial (c-RCT). As a key component of the implementation strategy, nominated nurses were trained as facilitators in a one-day workshop and supported by peer-mentoring (visit, telephone counselling). A mixed-methods approach was conducted in conjunction with the pilot trial and guided by a framework for process evaluations of c-RCTs. Data were collected using standardised questionnaires (nursing staff), documentation forms, problem-centred qualitative interviews (facilitators, therapists, social workers, relatives, peer-mentors), and a group discussion (facilitators). A set of predefined criteria on the nursing home level was examined. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using directed content analysis. Results Seven nursing homes (n = 4 intervention groups, n = 3 control groups) in two regions of Germany took part in the study. Facilitators responded well to the qualification measures (workshop participation: 14/14; workshop rating: “good”; peer-mentor visit participation: 10/14). The usage of peer-mentoring via telephone varied (one to seven contacts per nursing home). Our implementation strategy was not successful in connection with supplying the intervention to all the nurses. The clear commitment of the entire nursing home and the respect for the expertise of different healthcare professionals were emphasised as enablers, whereas a lack of impact on organisational conditions and routines and a lack of time and staff competence were mentioned as barriers. Conclusion The PECAN intervention was delivered as planned to the facilitators but was unable to produce comprehensive changes in the nursing homes and subsequently for the residents. Strategies to systematically include the management and the nursing team from the beginning are needed to support the facilitators during implementation in the main trial. Trial registration German clinical trials register, DRKS00010037. Registered 12 February 2016.
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Affiliation(s)
- Hanna Klingshirn
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr 17, 81377, Munich, Germany.,Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany
| | - Martin Müller
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany
| | - Katrin Beutner
- Institute for Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Julian Hirt
- Institute for Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Ralf Strobl
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr 17, 81377, Munich, Germany.,German Centre for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Marchioninistr 15, 81377, Munich, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr 17, 81377, Munich, Germany.,German Centre for Vertigo and Balance Disorders, Ludwig-Maximilians-Universität München, Marchioninistr 15, 81377, Munich, Germany
| | - Gabriele Meyer
- Institute for Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Susanne Saal
- Institute for Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
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Saal S, Klingshirn H, Beutner K, Strobl R, Grill E, Müller M, Meyer G. Improved participation of older people with joint contractures living in nursing homes: feasibility of study procedures in a cluster-randomised pilot trial. Trials 2019; 20:411. [PMID: 31288846 PMCID: PMC6617884 DOI: 10.1186/s13063-019-3522-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 06/12/2019] [Indexed: 11/18/2022] Open
Abstract
Background Acquired joint contractures have a significant impact on functioning and quality of life in nursing home residents. There is very limited evidence on measures for prevention and treatment of disability due to joint contractures. We have developed the PECAN intervention (Participation Enabling CAre in Nursing) to improve social participation in nursing home residents. A cluster-randomised pilot trial was conducted to assess the feasibility of study procedures in preparation for a main trial according to the UK Medical Research Council (MRC) framework. Methods Nursing homes in two regions of Germany were randomly allocated either to the intervention or optimised standard care (control group). All residents with joint contractures aged > 65 years were eligible for the study. The residents’ data were collected through structured face-to-face interviews by blinded assessors at baseline, after 3 and 6 months. The primary outcome was social participation, measured by a subscale of the PaArticular Scales. Secondary outcomes included activities and instrumental activities of daily living, health-related quality of life, falls and fall-related consequences. Data on the trial feasibility were collected via documentation forms. Results Seven out of 12 nursing homes agreed to participate and remained in the trial. Of 265 residents who fulfilled the inclusion criteria, 129 were randomised either to the intervention (n = 64) or control group (n = 65) and analysed. A total of 109 (85%) completed the trial after 6 months. The mean age was 85.7 years (SD 7.0), 80% were women. The severity of the residents’ disability differed across the clusters. The completion rate was high (> 95%), apart from the Instrumental Activities of Daily Living Scale. Some items of the PaArticular Scales were not easily understood by residents. The frequency of falls did not differ between study groups. Conclusion Our data confirmed the feasibility of the overall study design. We also revealed the need to improve the procedures for the recruitment of residents and for data collection before implementation into a main trial. The next step will be an adequately powered main trial to assess the effectiveness and cost-effectiveness of the intervention. Trial registration German clinical trials register, ID: DRKS00010037. Registered on 12 February 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3522-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Susanne Saal
- Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University, Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
| | - Hanna Klingshirn
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig -Maximilians-University Munich, Marchioninistr 15, 81377, Munich, Germany
| | - Katrin Beutner
- Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University, Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Ralf Strobl
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig -Maximilians-University Munich, Marchioninistr 15, 81377, Munich, Germany.,German Center for Vertigo and Balance Disorders, Ludwig- Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig -Maximilians-University Munich, Marchioninistr 15, 81377, Munich, Germany.,German Center for Vertigo and Balance Disorders, Ludwig- Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Martin Müller
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University, Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
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Nguyen N, Thalhammer R, Beutner K, Saal S, Servaty R, Klingshirn H, Icks A, Freyberg K, Vomhof M, Mansmann U, Le L, Müller M, Meyer G. Effectiveness of a complex intervention to improve participation and activities in nursing home residents with joint contractures (JointConEval): study protocol of a multicentre cluster-randomised controlled trial [DRKS-ID:DRKS00015185]. Trials 2019; 20:305. [PMID: 31142350 PMCID: PMC6542100 DOI: 10.1186/s13063-019-3384-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 04/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nursing home residents are frequently affected by joint contractures, which impacts their participation and daily activities. A complex intervention, the Participation Enabling Care in Nursing (PECAN), was previously developed and pilot tested to address their needs. Its effectiveness and safety will be evaluated in the present study. METHODS/DESIGN This multicentre cluster-randomised controlled trial will be conducted in 32 nursing homes spread over two regions of Germany. A total of 578 residents over 65 years old with joint contractures will be included. To compare the effect of the PECAN intervention with optimised standard care (usual care and an information session), randomisation will take place at a cluster level. The individually tailored intervention was designed using the biopsychosocial model in the International Classification of Functioning, Disability and Health (ICF) to reduce activity limitations and participation restrictions resulting from existing joint contractures by addressing barriers and by strengthening supportive factors on an individual level and an organisational level. The implementation strategy comprises a facilitators' workshop, a peer mentoring approach including a peer mentor visit and telephone peer counselling, an in-house information event, an information session for the nursing team and a training session on collegial consultation for the facilitators. The in-house information event will also take place in the nursing homes of the control group. The primary outcome is the residents' participation and activities after 12 months of follow-up as assessed using the PaArticular Scales. The secondary outcome is the residents' quality of life. A cost-effectiveness analysis (costs per additional resident who experienced a decrease of ten points in the participation or activities subscale of the PaArticular Scales) and a cost-utility analysis (costs per additional quality adjusted life year) will be conducted. We will investigate barriers and facilitators in a comprehensive process evaluation. DISCUSSION We expect a clinically relevant improvement of participation and activities in residents with joint contractures. Our findings will provide important insights regarding participation in the situation of the affected individuals. TRIAL REGISTRATION DRKS, DRKS00015185 . Registered on 1 August 2018. Universal Trial Number U1111-1218-1555. Registered on 26 July 2018.
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Affiliation(s)
- Natalie Nguyen
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Saale Germany
| | - Regina Thalhammer
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
| | - Katrin Beutner
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Saale Germany
| | - Susanne Saal
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Saale Germany
| | - Ricarda Servaty
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
| | - Hanna Klingshirn
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Düsseldorf, Germany
| | - Kristina Freyberg
- Department of Medical Controlling, University Hospital Bonn, Bonn, Germany
| | - Markus Vomhof
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Düsseldorf, Germany
| | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Lien Le
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Martin Müller
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Saale Germany
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Müller M. Die Internationale Klassifikation von Funktionsfähigkeit, Behinderung und Gesundheit (ICF) – Ein nützliches Instrument für die Pflegewissenschaft? Pflege 2018; 31:289-290. [PMID: 30466381 DOI: 10.1024/1012-5302/a000644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Park MS, Kang KJ, Jang SJ, Lee JY, Chang SJ. Evaluating test-retest reliability in patient-reported outcome measures for older people: A systematic review. Int J Nurs Stud 2018; 79:58-69. [DOI: 10.1016/j.ijnurstu.2017.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/07/2017] [Accepted: 11/07/2017] [Indexed: 12/24/2022]
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