Failed implementation of a nursing intervention to support family caregivers: An evaluation study using Normalization Process Theory.
Yvonne N Becqué, Judith A C Rietjens, Agnes van der Heide and 1 others
PMID 38884574WHAT IT FOUND
Nurses valued the family caregiver needs tool in end-of-life care after using it, but many did not see it as different from usual care; staff shortages, late referrals and trial recruitment duties blocked routine use.
Key findings
01Before the intervention, 68% of nurses said they did not know instruments or tools to assess family caregiver burden or support needs in end-of-life care.
02After using the intervention, nurses reported increased awareness of family caregivers' position and more open communication with them.
03Concerns about burdening caregivers and late referrals made nurses hesitant to invite family caregivers into the study.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The evaluation used data collected for a trial, not designed for this implementation study, so it may miss targeted questions about why recruitment failed. The analysis mainly used Normalization Process Theory, which focuses on professionals' perspectives, and did not fully assess family caregivers' own views on why the trial failed. The original trial stopped early with only 12 family caregivers participating, so it could not test the intervention's effects on burden, preparedness, caregiving reactions or acute admissions. The evaluation combined published and unpublished data from different sources, including interviews, questionnaires, emails, notes and nursing files, which may not represent all teams or all caregiver experiences. The researcher's independent, distant role and the trial context may have shaped nurses' willingness to participate and report experiences.
Declared interests
The study was funded by the Netherlands Organization for Health Research and Development (ZonMw), and the authors declared no conflict of interest.
The easy way to misread this
Do not read this as evidence that the intervention improved family caregiver burden. The original trial stopped early with 12 family caregivers participating out of 184 planned, and this evaluation reports implementation themes, not patient outcomes.