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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
  1. Lieve M Roets-Merken1,2,
  2. Myrra J F J Vernooij-Dassen1,
  3. Sytse U Zuidema3,
  4. Marianne K Dees4,
  5. Pieter G J M Hermsen5,
  6. Gertrudis I J M Kempen6,
  7. Maud J L Graff1
  1. 1Radboud University Medical Center, Donders Center for Cognition, Brain & Behavior, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
  2. 2Kalorama Foundation, Beek-Ubbergen, The Netherlands
  3. 3University of Groningen, University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, Groningen, The Netherlands
  4. 4Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
  5. 5Severinus Foundation, Veldhoven, The Netherlands
  6. 6Maastricht University, Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
  1. Correspondence to Lieve M Roets-Merken; Lieve.roets-merken{at}


Objectives 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.

Design Qualitative study alongside a cluster randomised controlled trial.

Setting 17 long-term care homes spread across the Netherlands.

Participants 34 licensed practical nurses supporting 54 dual sensory impaired older adults.

Intervention A 5-month training programme designed to enable nurses to support the self-management of dual sensory impaired older adults in long-term care.

Primary outcomes 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.

Results 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.

Conclusions 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.

Trial registration number NCT01217502, Post-results.


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  • Contributors LMR-M, MJFJV-D, GIJMK, PGJMH and SUZ performed the study concept and design, and MKD and LMR-M the qualitative data analysis. All authors were involved in revising the manuscript and read and approved the final version of the manuscript. The corresponding author and all co-authors had full access to the study data and had final responsibility for the decision to submit for publication.

  • Funding This study was financially supported by the Joannes de Deo Foundation and the Mother Catharina Fund, the Netherlands.

  • Competing interests None declared.

  • Ethics approval The study design and protocol has been approved by the Dutch Committee on Research involving Human Subjects region Arnhem-Nijmegen, ABR 26192.091.08.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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