title: Evaluation of nurses' changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care: a qualitative study.
abstract: To gain insights into the process of nurses' changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care, and into the factors that contributed to these changes in their perceptions.
  
  
  
  Qualitative study alongside a cluster randomised controlled trial.
  
  
  
  17 long-term care homes spread across the Netherlands.
  
  
  
  34 licensed practical nurses supporting 54 dual sensory impaired older adults.
  
  
  
  A 5-month training programme designed to enable nurses to support the self-management of dual sensory impaired older adults in long-term care.
  
  
  
  Nurses' perceptions on relevance and feasibility of the self-management programme collected from nurses' semistructured coaching diaries over the 5-month training and intervention period, as well as from trainers' reports.
  
  
  
  Nurses' initial negative perceptions on relevance and feasibility of the intervention changed to positive as nurses better understood the concept of autonomy. Through interactions with older adults and by self-evaluations of the effect of their behaviour, nurses discovered that their usual care conflicted with client autonomy. From that moment, nurses felt encouraged to adapt their behaviour to the older adults' autonomy needs. However, nurses' initial unfamiliarity with conversation techniques required a longer exploration period than planned. Once client autonomy was understood, nurses recommended expanding the intervention as a generic approach to all their clients, whether dual sensory impaired or not.
  
  
  
  Longitudinal data collection enabled exploration of nurses' changes in perceptions when moving towards self-management support. The training programme stimulated nurses to go beyond 'protocol thinking', discovering client autonomy and exploring the need for their own behavioural adaptations. Educational programmes for practical nurses should offer more longitudinal coaching of autonomy supportive conversational skills. Intervention programming should acknowledge that change is a process rather than an event, and should include self-evaluations of professional behaviours over a period of time.
  
  
  
  NCT01217502, Post-results.
authors.affiliation: Radboud University Medical Center, Donders Center for Cognition, Brain & Behavior, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands.|Kalorama Foundation, Beek-Ubbergen, The Netherlands.
authors.forename: Lieve M
authors.initials: LM
authors.lastname: Roets-Merken
authors.affiliation: Radboud University Medical Center, Donders Center for Cognition, Brain & Behavior, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands.
authors.forename: Myrra J F J
authors.initials: MJ
authors.lastname: Vernooij-Dassen
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, The Netherlands.
authors.forename: Sytse U
authors.initials: SU
authors.lastname: Zuidema
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.
authors.forename: Marianne K
authors.initials: MK
authors.lastname: Dees
authors.affiliation: Severinus Foundation, Veldhoven, The Netherlands.
authors.forename: Pieter G J M
authors.initials: PG
authors.lastname: Hermsen
authors.affiliation: Maastricht University, Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands.
authors.forename: Gertrudis I J M
authors.initials: GI
authors.lastname: Kempen
authors.affiliation: Radboud University Medical Center, Donders Center for Cognition, Brain & Behavior, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands.
authors.forename: Maud J L
authors.initials: MJ
authors.lastname: Graff
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D001291:Attitude of Health Personnel; D059026:Diagnostic Self Evaluation; D004506:Education, Nursing / Q000379:methods; D034381:Hearing Loss / Q000451:nursing*; D006801:Humans; D008134:Long-Term Care; D008137:Longitudinal Studies; D009426:Netherlands; D009726:Nurses; D036301:Qualitative Research; D012648:Self Care / Q000379:methods*; D014786:Vision Disorders / Q000451:nursing*
keywords: AUTONOMY; DUAL SENSORY IMPAIRMENT; OLDER PEOPLE; QUALITATIVE RESEARCH; SELF-MANAGEMENT