Why a carefully designed, nurse-led intervention failed to meet expectations

The case of the Care Programme for Palliative Radiotherapy

C.V. Vahedi Nikbakht-van de Sande, C. Braat, A.P. Vissers, D. Delnoij, A.L. Staa

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Purpose of the research
Implement and evaluate the Care Programme for Palliative Radiotherapy (CPPR) in the Outpatient Clinic of the Department of Radiotherapy, Erasmus MC-Cancer Institute, Rotterdam, The Netherlands.
Methods
Participatory Action Research (PAR). Qualitative descriptive design: participatory observations, semi-structured interviews with patients and professionals and focus groups with professionals; content analysis of documents.
Sample
Patients with impending paraplegia due to metastatic spinal cord compression, nurse practitioners (NPs), nurse manager, staff and ward nurses, radiographers, radiotherapists and medical doctors.
Key results
After a shift from inpatient to outpatient radiotherapy treatment, patients and healthcare professionals perceived shortcomings in the oncological chain care. The CPPR was developed in a participative way giving a key role to the NP. Evaluation after implementation of the programme showed that patients and professionals were predominantly positive about its effects. However, implementation was not sustained due to lack of institutional and managerial support.
Conclusions
The technological innovation far preceded the organisational changes needed to provide innovative, patient-centred care. Implementing this programme with a central role for the NP was seen as the solution to the problems identified. However, in spite of the systematic approach using PAR, the programme was not successful in bringing about sustained improvements. NPs fulfil a valuable role in the care and support of patients with palliative care needs but need institutional support. More attention should have paid to the organisational context. Involve all relevant actors; use a participatory approach to enhance commitment; ensure the support of management during the whole project.
Original languageEnglish
Pages (from-to)151-158
JournalEuropean Journal of Oncology Nursing
Volume18
Issue number2
DOIs
Publication statusPublished - 2014

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Nurse Practitioners
Palliative Care
Nurses
Inventions
Organizational Innovation
Nurse Administrators
Ambulatory Care Facilities
Focus Groups
Netherlands
Inpatients
Outpatients
Interviews
Delivery of Health Care
Neoplasms

Cite this

Vahedi Nikbakht-van de Sande, C.V. ; Braat, C. ; Vissers, A.P. ; Delnoij, D. ; Staa, A.L. / Why a carefully designed, nurse-led intervention failed to meet expectations : The case of the Care Programme for Palliative Radiotherapy. In: European Journal of Oncology Nursing. 2014 ; Vol. 18, No. 2. pp. 151-158.
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abstract = "Purpose of the researchImplement and evaluate the Care Programme for Palliative Radiotherapy (CPPR) in the Outpatient Clinic of the Department of Radiotherapy, Erasmus MC-Cancer Institute, Rotterdam, The Netherlands.MethodsParticipatory Action Research (PAR). Qualitative descriptive design: participatory observations, semi-structured interviews with patients and professionals and focus groups with professionals; content analysis of documents.SamplePatients with impending paraplegia due to metastatic spinal cord compression, nurse practitioners (NPs), nurse manager, staff and ward nurses, radiographers, radiotherapists and medical doctors.Key resultsAfter a shift from inpatient to outpatient radiotherapy treatment, patients and healthcare professionals perceived shortcomings in the oncological chain care. The CPPR was developed in a participative way giving a key role to the NP. Evaluation after implementation of the programme showed that patients and professionals were predominantly positive about its effects. However, implementation was not sustained due to lack of institutional and managerial support.ConclusionsThe technological innovation far preceded the organisational changes needed to provide innovative, patient-centred care. Implementing this programme with a central role for the NP was seen as the solution to the problems identified. However, in spite of the systematic approach using PAR, the programme was not successful in bringing about sustained improvements. NPs fulfil a valuable role in the care and support of patients with palliative care needs but need institutional support. More attention should have paid to the organisational context. Involve all relevant actors; use a participatory approach to enhance commitment; ensure the support of management during the whole project.",
author = "{Vahedi Nikbakht-van de Sande}, C.V. and C. Braat and A.P. Vissers and D. Delnoij and A.L. Staa",
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Why a carefully designed, nurse-led intervention failed to meet expectations : The case of the Care Programme for Palliative Radiotherapy. / Vahedi Nikbakht-van de Sande, C.V.; Braat, C.; Vissers, A.P.; Delnoij, D.; Staa, A.L.

In: European Journal of Oncology Nursing, Vol. 18, No. 2, 2014, p. 151-158.

Research output: Contribution to journalArticleScientificpeer-review

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T1 - Why a carefully designed, nurse-led intervention failed to meet expectations

T2 - The case of the Care Programme for Palliative Radiotherapy

AU - Vahedi Nikbakht-van de Sande, C.V.

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AU - Staa, A.L.

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N2 - Purpose of the researchImplement and evaluate the Care Programme for Palliative Radiotherapy (CPPR) in the Outpatient Clinic of the Department of Radiotherapy, Erasmus MC-Cancer Institute, Rotterdam, The Netherlands.MethodsParticipatory Action Research (PAR). Qualitative descriptive design: participatory observations, semi-structured interviews with patients and professionals and focus groups with professionals; content analysis of documents.SamplePatients with impending paraplegia due to metastatic spinal cord compression, nurse practitioners (NPs), nurse manager, staff and ward nurses, radiographers, radiotherapists and medical doctors.Key resultsAfter a shift from inpatient to outpatient radiotherapy treatment, patients and healthcare professionals perceived shortcomings in the oncological chain care. The CPPR was developed in a participative way giving a key role to the NP. Evaluation after implementation of the programme showed that patients and professionals were predominantly positive about its effects. However, implementation was not sustained due to lack of institutional and managerial support.ConclusionsThe technological innovation far preceded the organisational changes needed to provide innovative, patient-centred care. Implementing this programme with a central role for the NP was seen as the solution to the problems identified. However, in spite of the systematic approach using PAR, the programme was not successful in bringing about sustained improvements. NPs fulfil a valuable role in the care and support of patients with palliative care needs but need institutional support. More attention should have paid to the organisational context. Involve all relevant actors; use a participatory approach to enhance commitment; ensure the support of management during the whole project.

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