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Open Access Research article

‘Stand still …, and move on’ , an early neurologically-focused follow-up for cardiac arrest survivors and their caregivers: a process evaluation

Véronique RM Moulaert12*, Jolanda CM van Haastregt3, Derick T Wade4, Caroline M van Heugten56 and Jeanine A Verbunt12

Author Affiliations

1 Adelante, Centre of Expertise in Rehabilitation and Audiology, Zandbergsweg 111, 6432 CC Hoensbroek, the Netherlands

2 Department of Rehabilitation Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre+, Maastricht, the Netherlands

3 Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre+, Maastricht, the Netherlands

4 Oxford Centre for Enablement, Nuffield Orthopaedic Centre, Oxford, UK

5 School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands

6 Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, the Netherlands

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BMC Health Services Research 2014, 14:34  doi:10.1186/1472-6963-14-34

Published: 23 January 2014

Abstract

Background

A cardiac arrest can lead to hypoxic-ischaemic brain injury which can result in cognitive and emotional impairments and may negatively affect daily functioning, participation in society and quality of life. Furthermore, the impact on the family of the patient can be high. We designed an intervention called ‘Stand still …, and move on’, which is a concise, individualised, semi-structured intervention for survivors of cardiac arrest and their caregivers, consisting of between one and six face-to-face consultations provided by a trained nurse. The intervention is directed at early detection of cognitive and emotional problems, provision of information, promotion of self-management and referral to specialised care if necessary. The effectiveness of the intervention is being examined in a randomised controlled trial [ISRCTN74835019]. Alongside this trial we performed a process evaluation which aims to investigate the feasibility of the intervention by assessing: 1) the attendance and dose delivered; 2) performance according to protocol; and 3) the opinion of patients, caregivers and nurses on the intervention.

Methods

Participants of this process evaluation were 97 patients allocated to the intervention group of the RCT, their 91 caregivers, and six nurses who conducted the intervention. Measurement instruments used were evaluation forms for patients and caregivers, registration and evaluation forms for nurses, and semi-structured interviews with nurses.

Results

Seventy-nine of the patients (81%) allocated to the intervention group and 65 caregivers (71%) participated in the intervention. The mean (SD) number of consultations per patient was 1.8 (1.0), and most consultations were conducted at the patients’ home. The intervention was performed largely according to protocol, except that the intervention usually started later than intended, consultations were longer than expected, and the topic of self-management was not regularly addressed. Patients marked the quality of the intervention with a mean score of 7.5 and the performance of the nurse with an 8.0 out of ten. Overall, the intervention was positively evaluated by patients, caregivers and nurses.

Conclusions

The intervention ‘Stand still …, and move on’ is a promising intervention which was performed largely according to protocol and seems feasible for implementation after some adaptations, if it is found to be effective.

Keywords:
Cardiac arrest; Hypoxic-ischaemic brain injury; Cognitive impairments; Emotional impairments; Caregiver; Nursing intervention; Feasibility; Process evaluation