Table 6 Overview of the central findings related to the key characteristics of WELCOME-IdA
WELCOME-IDA | Response |
|---|---|
Role structure | |
 Moderator | |
 − Internal or external person | − Often external moderator |
 − Training in moderating the DSCC | − Training in moderating the DSCC, regular peer debriefing |
 − Task: Ensure adherence to the method | − Task: Ensure adherence to method, e.g., by defining a certain seating arrangement |
 − Task: Ensure adherence to time frame | − Task: Ensure adherence to the time frame (partly performed by an additional co-moderator) |
 − Task: Ensure adherence to roles | − Task: Ensure adherence to roles and define rules for temporarily stepping out of one’s role |
− Task: Gain experience in each role and be a reference person for less experienced colleagues (peer support) | |
 Case reporter | |
 − Internal person, primary caregiver of the resident | − Internal person, both the primary caregiver and a trained moderator |
 − Task: Prepare necessary case information | − Task: Prepare necessary case information, partly performed by two persons in tandem |
 − Task: Present the initial problem and define expectations for the DSCC | − Task: Present the initial problem and define expectations for the DSCC; process all IdA domains (a-e) in preparation for the DSCC and pre-select domain(s) for the behaviour analysis |
 − Task: Ensure subsequent integration of agreed upon care interventions into daily nursing practice | − Task: Ensure subsequent integration of agreed-upon care interventions into daily nursing practice (partly performed by a trained moderator/leading ward nurse) |
 Keeper of the minutes | |
 − Internal person | − Both an internal person and external person |
 − Task: Complete the IdA during the DSCC | − Task: Complete the IdA during the DSCC; in case of previously completed domains, document solely changes resulting from the discussion |
 − Task: Document central results in a protocol | − Task: Document central results in a protocol, partly with the collaboration of additional keepers of the minutes |
 Reflection partner | |
 − 2–5 internal persons (core team members) | − Different persons, no core team, a mixture of nursing staff from different wards, inclusion of social service staff |
 − Tasks: Answer the IdA questions by gathering and supplementing information, provide critical but supportive feedback, form hypotheses and develop hypothesis-driven care interventions | − Tasks: Answer the IdA questions by gathering and supplementing information, provide critical but supportive feedback, form hypotheses and develop hypothesis-driven care interventions |
Group size | |
  − 5–8 participants | − Expanded group size to include more staff members, reduced group size due to small size of facility |
Core nursing teams | |
 − 2–5 people should continuously participate in every DSCC | − No core nursing team due to several reasons: ad hoc selection of DSCC participants; aim to include more staff members; small size of facility; and absence of staff due to vacation, illness, and part-time employment |
Process structure | |
 Formal preparation for the DSCC | |
 − Invitation of DSCC participants | − Invitation of DSCC participants, planning compensatory staff |
 − Recording of time and date in the duty roster | − Recording of time and date in the duty roster early |
 Selection of the case | |
 − Suggestions made by any team member and decision made by the team | − Suggestions can be made by any team member; decision is mostly made by the team based on observed difficulties |
− DSCC is repeated in case of failed interventions | |
 Handling of the IdA in preparation for the DSCC | |
− Use of the IdA to outline, at minimum, the problem to be discussed and expectations for the DSCC | − Processing of all IdA domains (a-e) in advance and pre-selection of domains for the behaviour analysis, both performed by the case reporter |
 Additional information | |
− Collection and preparation of background information on the resident | − Collection and preparation of biographical and medical background information on the resident |
 Handling of the IdA in the DSCC | |
− Formulation of hypotheses after the discussion of each domain | − Formulation of hypotheses after the discussion of each domain, in part and only at one point after the discussion of all domains |
− Use of all five domains | − Use of selected domains; the number depends on the case characteristics and time frame of the DSCC |
 Dissemination of information | |
− Dissemination of information about the results of the DSCC to entire nursing team and documentation of results in the nursing record | − Dissemination of information about the results of the DSCC to the entire nursing team through verbal briefing, flip chart documentation, written minutes and/or the intranet and documentation of results in the nursing record; difficulty of disseminating information to night and part-time staff |
 Delivery of the care interventions | |
− Integration of hypothesis-driven care intervention into nursing practice after the DSCC | − Integration of hypothesis-driven care intervention into nursing practice after the DSCC |
− Difficulty of defining reasonable time frames for the delivery of interventions and of ensuring timely delivery in case of multiple interventions | |
− Inhibiting factors: involvement of external people, vacation time, and overall high workload | |
− Promoting factors: defined responsibility and defined time limit | |
 Evaluation of the care interventions | |
− Evaluation at the beginning of the subsequent DSCC | − Shifting evaluation to team meetings due to a lack of DSCC participant continuity |
− Partly visual evaluation system suitable for prompt and ongoing evaluation | |