Introduction:For the past decade, the Netherlands has been developing and implementing reablement programs to promote independence and to empower older adults' autonomy. However, a key challenge remains the lack of clarity around the definition of reablement and its relations to usual care practices. Existing international definitions lack specificity to account for contextual differences, such as variations in healthcare systems and cultural norms. An operational definition is needed that not only fits the Dutch health and social care system and incorporates context-specific elements. This study extends the original conceptual definition by integrating these elements, offering clearer, more practical guidance for real-world application. Materials and methods:A modified Delphi study was performed to develop a definition of reablement that fits the Dutch health and social care system, extending beyond conceptual understanding. The study comprised three expert rounds and three Delphi survey rounds. Results:A total of 139 participants from Dutch health and social care, education, research, and representatives of clients and informal caregivers, participated. They evaluated statements in four sections: the target group, aims, type of care or support, and characteristics of reablement programs. Key discussions during the expert rounds focused mainly on 1) the target group, emphasizing the importance of involving individuals and their families, and 2) the characteristics of reablement, such as coordinating roles, team composition, and size. Input from the Delphi surveys and expert rounds led to the development of an operational definition for the Dutch context, agreed upon by 81% of stakeholders. Conclusion:The Delphi methodology proved valuable in identifying context-specific elements and incorporating expert perspectives, creating a culturally and contextually sensitive definition. This definition distinguishes itself from the international version by offering practical guidance on areas of application and interventions, with a focus on promoting social participation, well-being, and the involvement of the individual's social network.

Purpose:Dementia refers to a group of neuro-cognitive disorders that affect people worldwide. Reablement may facilitate people to maintain or regain abilities, encourage engagement in activities important to them, promote continued societal participation, and foster a meaningful life experience. However, the adoption of reablement in dementia care has been slow. This study aimed to explore the negative attitudes that hinder the adoption of reablement and to identify strategies to mitigate these factors. Methods:An exploratory qualitative approach involving semi-structured interviews was adopted. Interviews were conducted with reablement and/or dementia experts in five countries, namely Australia, Denmark, the Netherlands, Sweden, and the United Kingdom. The interviews were recorded and transcribed verbatim. The interviews were analyzed using a thematic analysis approach. Results:This study explored the views of 10 experts and identified negative attitudes that impede the adoption of reablement. These attitudes were grouped into five themes: 1) lack of understanding of the preserved capabilities in people with dementia, 2) reluctance and fear among family caregivers about disrupting established routines, 3) institutional barriers, 4) misinterpretation of what reablement is, and 5) complexity of the healthcare system. The proposed strategies to address these negative attitudes include enhancing dementia awareness, educating family caregivers, understanding caregiver burden, taking care of community education and destigmatization, improving clinical leadership, raising awareness about reablement evidence and practice, integrating reablement in educational curriculum, developing comprehensive policies, and improving access to services. Conclusion:This study highlights the importance of addressing and mitigating negative attitudes which obstruct adoption of reablement. By identifying these attitudes and exploring their origin, strategies can be formulated to overcome them. Successful adoption of these strategies is anticipated to enhance the quality of life of people with dementia and their caregivers.

This study aims to evaluate the cost-effectiveness and cost-utility of the SElf-reliance, autonomy, Life quality, and Functionality-program (SELF) for nursing staff in nursing homes who provide long-term care to geriatric clients as compared to care as usual from a societal perspective. The economic evaluation ran parallel to a two-arm multicenter cluster-randomized trial, in which the nursing staff in the intervention group received the SELF-program, and nursing staff in the control group received no program and delivered care as usual. Outcomes and societal costs for clients who received care from nursing staff were measured using questionnaires at baseline, 3 months, and 6 months. The main measures included Activities of Daily Living, as measured with the GARS-4, utility scores as measured with the EQ-5D-5L, and costs related to the intervention, informal care and health service utilization. Cost-effectiveness and cost-utility analyses were conducted, calculating incremental cost-effectiveness ratios from societal and healthcare perspectives. Bootstrap analyses were performed, with results displayed on cost-effectiveness planes and acceptability curves. In total, 28 wards with a total of 241 clients were randomized (intervention, n = 115; control group, n = 126) From a societal perspective, care delivered in the intervention group led to lower costs than care as usual over the 6-month period, with incremental costs of -€584. In terms of the GARS-4 sum score, the SELF-program resulted in a favorable decrease of 0.81 points, and in terms of QALYs, it resulted in a favorable increase of 0.07. From a healthcare perspective, the incremental costs amounted to €556, with ratios of €410 per point reduction on the GARS-4 and €8,356 per QALY. The main analysis suggests that over 6 months from a societal perspective for both outcomes, the intervention is cost-effective as compared to care as usual. International Clinical Trials Registry Platform: NL9189; https://trialsearch.who.int/Trial2.aspx?TrialID=NL9189.

Background:Function Focused Care is a promising approach stimulating physical activity of patients admitted to hospital. In studying the effectiveness, patients receiving Function Focused Care in Hospital were admitted 3.3 days shorter than patients receiving usual care. However, no differences were found in functional status. Process evaluations alongside an effect studies create an understanding implementation fidelity, of mechanisms of impact, contextual factors. Objective:to gain insight into the experiences of nurses and patients, and to give insight into implementation fidelity, mechanisms of impact, and contextual factors while implementing Function Focused Care in Hospital on geriatric and neurologic hospital wards. Design:convergent parallel mixed-methods study, alongside a stepped wedge clinical trial. Settings:four hospital wards of two Dutch hospitals. Participants:nurses, nursing students and care assistants (n = 123), and patients (n = 24). Methods:Data for the process evaluation was collected before the implementation of Function Focused Care in Hospital (T0), directly after implementation (T1), and four months after implementation (T2). Data was obtained from patient interviews, focus group interviews with nurses, questionnaires, observations, screening of electronic patients' records, and logbook notes. For the qualitative data thematic analyses and for quantitative data descriptive statistics were used. The results of these analyses were synthesized into overarching findings. Results:Findings from the observations showed the care delivery according to the Function Focused Care in Hospital principles increased from 60 % in the control condition to 75 % in the intervention condition. Moreover, nurses stated that patients were only assisted when needed and nurses often asked about their abilities to perform ADL and then encouraged them to do as much as they could themselves. Nevertheless, patients don't recognize Function Focused Care in Hospital. The results suggest that the implementation fidelity was influenced by different working mechanisms and contextual factors which led to different experiences from nurses, coaches and patients in promoting patient engagement and functional independence. The synthesized findings show that lessons can be learned with regards to continuity of the care provided in the interprofessional collaboration, the challenge in providing personalized care given the current time constraints, the phenomenon of being unconscious incompetent observed in the nurses, and difficulties in demonstrating nursing leadership and autonomy. Conclusions:Implementation of Function Focused Care in Hospital improved care delivery but highlighted challenges in personalized care, interprofessional collaboration, and nursing leadership, influenced by various contextual factors and working mechanisms. Registration:https://onderzoekmetmensen.nl/en/trial/24287 (date of first recruitment: 05-02-2016).

Introduction:Many older individuals face complex health and social care issues that require an integrated care approach. However, current health and social care services are often fragmented in terms of financing, organisation, and delivery, and therefore do not fit the needs of older individuals. Reablement is an innovative integrated approach that aims to 'help individuals to help themselves' by providing goal-oriented, person-centred care. An interdisciplinary team works intensively with individuals towards their goals, while considering their capabilities and contextual factors. Description:The aim of this study was to assess the feasibility of a Dutch reablement programme in terms of acceptability, implementation, practicality, adaptation, integration, and limited efficacy. Using qualitative methods, six clients, three informal caregivers, eight care professionals, and one programme director were interviewed, complemented by data from electronic care files. Findings indicated positive stakeholder experiences. Discussion:Despite positive experiences, three key challenges emerged: 1) behaviour change; 2) in- and external interprofessional collaboration; and 3) enrolment. The study underscores the complexity of implementing and integrating reablement in community care. Conclusion:Our findings offer critical insights that could guide future efforts to implement reablement programmes more effectively.

Purpose: Over the last two decades, reablement programs have been studied and implemented internationally. Goal-setting and multidisciplinary collaboration are central elements of reablement. Unfortunately, limited intervention descriptions leave questions on how they are applied in practice and how goals set by the user are achieved. As a consequence, healthcare providers and organizations often lack knowledge to implement and align reablement to their national and local context. This study aimed to collect data on goalsetting and achievement, and multidisciplinary collaboration within reablement services to provide insight into how these processes inform reablement practice as well as to explore the experiences of healthcare professionals in Norway, New Zealand, and the Material and Methods: A qualitative exploratory design was used comprising three focus group interviews with 20 healthcare professionals (nursing and allied health) involved in reablement programs from the three countries. Purposive sampling was employed considering a mix of gender, age and educational level. Results: Findings reflected healthcare professionals' experiences and reablement processes in three main themes: (1) Goal-setting processes; clearly demonstrating goal-setting as an essential part of reablement and contributing to better understanding of users' motives; (2) Impact of goal-setting on multidisciplinary collaboration; promoting a sense of community, learning climate, job satisfaction and task-shifting; and (3) Behavior change techniques used to reach users' goals, promoting self-reflection and changing users' perspectives. Conclusion: This study offers valuable insights from three countries. Goal-setting serves a crucial role enabling effective reablement implementation across diverse contexts. More specifically, to facilitate tailoring of reablement programs to the user's needs as well as establish more effective multidisciplinary collaboration by promoting trust, shared vision, and utilizing each other's expertise. However, despite the acknowledgement of the significance of reablement, it was reported by all that a cultural shift is necessary for users, informal caregivers as well as healthcare professionals.

The World Health Organization (WHO) recognizes the right of individuals with dementia and their family caregivers to access interventions that enhance their participation in society. Reablement is an approach that enables older people to participate in meaningful daily and social activities. Over the past decade, a growing body of evidence has underscored reablement as a promising approach within dementia care, including positive outcomes for people with dementia and their family caregivers, and cost-effectiveness. However, the dissemination of knowledge about and practical implementation of reablement remain slow. This position paper, authored by the ReableDEM research network, aims to address key issues related to implementing reablement in dementia care. To expedite the adoption of reablement within dementia care, we propose five critical areas of focus: 1) Changing the attitudes and expectations of stakeholders (eg health and social care staff, policy makers, funders) - encouraging people to think about dementia as a disability from a biopsychosocial perspective; 2) Disrupting health and social care - A radical change is needed in the way services are organized so that they are more holistic, personalized and resource-oriented; 3) Investing in capacity-building and creating a supportive environment - the workforce needs to be trained and supported to implement reablement in dementia care; 4) Involving, educating and supporting family caregivers - services and staff that are equipped to provide reablement will be better able to involve family caregivers and the person's social network; 5) Providing robust evidence about reablement in dementia care by conducting high-quality research with long-term follow-up.

BACKGROUND:Goal setting is an essential component of reablement programmes. At the same time it is also an important aspect in the evaluation of reablement from the perspective of clients. OBJECTIVES:As part of the TRANS-SENIOR project, this research aims to get an in-depth insight of goal setting and goal attainment within reablement services from the perspective of the older person. MATERIAL AND METHODS:A convergent mixed methods design was used, combining data from electronic care files, and completed Canadian Occupational Performance Measure (COPM) forms with individual interviews. RESULTS:In total, 17 clients participated. Participants' meaningful goals mainly focused on self-care, rather than leisure or productivity. This mattered most to them, since being independent in performing self-care tasks increased clients' confidence and perseverance. Regarding goal attainment, a statistically significant and clinically relevant increase in self-perceived performance and satisfaction scores were observed. CONCLUSION:Although most goals focused on self-care, it became apparent that these tasks matter to participants, especially because these often precede fundamental life goals. SIGNIFICANCE:Reablement can positively contribute to goal setting and attainment of clients and may contribute to increased independence. However, effectiveness, and subsequently long-term effects, are not yet accomplished and should be evaluated in future research.

Background During acute hospital admission, patients often experience loss of functional status. A low level of physical activity is associated with higher levels of loss of functional status. Stimulating physical activity to maintain functional status is considered essential nursing care. Function Focused Care is a promising approach stimulating physical activity. In a previous study, Function Focused Care in Hospital was deemed feasible. Objective To determine the effectiveness of Function Focused Care in Hospital compared with usual care on the functional status of hospitalized stroke and geriatric patients. Design A multicenter stepped wedge cluster trial. Methods A neurological and a geriatric ward of an academic hospital and a general hospital in the Netherlands participated in this study; each was considered a cluster in the trial. The primary outcome was patients' functional status over time, measured with the Barthel Index and Elderly Mobility Scale. Secondary outcomes were the patients' length of stay, fear of falling, self-efficacy, motivation, resilience, and outcome expectations for functional and exercise activities. Data was collected at hospital admission (baseline), day of discharge, and three and six months after discharge via patient files and questionnaires and analyzed with generalized linear mixed models. Results In total, we included 892 patients, of which 427 received Function Focused Care in Hospital and 465 received usual care. Although we did not find significant differences in the Barthel Index and Elderly Mobility Scale at discharge or follow-up, we found a significant decrease in the mean length of stay (- 3.3 days, 95 % CI - 5.3 to - 1.1) in favor of the Function Focused Care in Hospital group. In addition, in the Function Focused Care in Hospital group, a larger proportion of patients were discharged to home compared to the control group (38.2 % vs. 29.0 %, p = 0.017), who were discharged more often to a care facility. Conclusion The length of hospital stay was substantially decreased, and discharge to home was more common in the group receiving Function Focused Care in Hospital with equal levels of independence in Activities of Daily Living and mobility in both groups upon discharge. Although significant differences in the Barthel Index and Elderly Mobility Scale were not found, we observed that neurological and geriatric patients were discharged significantly earlier compared to the control group. Registration https://onderzoekmetmensen.nl/en/trial/24287 (date of first recruitment: 05-02-2016). Tweetable abstract: Patients receiving Function Focused Care in Hospital were discharged from the hospital 3.3 days earlier and discharged home more often than the group of patients receiving care as usual. @umcutrecht @ hogeschoolutrecht. (c) 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Reablement is considered a complex intervention due to its multicomponent, person-centered, holistic approach promoting older adults’ active participation in daily activities. It is important to consider the unique context in which complex interventions are implemented, as contextual factors may interact and influence implementation outcomes. As part of the European TRANS-SENIOR project, this qualitative study aimed to gain insight into professionals’ experiences with reablement implementation in Dutch community care. Using the Consolidated Framework for Implementation Research, four focus groups were conducted comprising 32 professionals. Two groups were formed: one at operational level, including therapists, nursing staff, social workers, and domestic support; and one at organizational/strategic level, including project leaders, managers, directors, municipality representatives and health insurers. Participating care organizations had at least 6 months of experience with deploying and implementing reablement. Findings reflected three themes: (1) strength of interdisciplinary collaboration; highlighting significance of sharing goals and beliefs, (2) integrating the reablement philosophy into the organization; underscoring managements role in fostering support across all organizational layers, and (3) achieving a culture change in the healthcare system; emphasizing current funding models impeding value-based care tailored to the individual’s goals and needs. The results offer valuable insights for implementation of complex interventions, like reablement.

Background: Nurses play a crucial role in encouraging nursing home resident's activity and independent functioning. However, nurses often take over tasks unnecessarily, which can deprive resident's remaining abilities. The Function-Focused Care philosophy offers guidance for developing programs that support nurses to optimize activity and independence of older people. However, such programs developed internationally have demonstrated inconsistent effects. Lessons have been gathered to improve future programs, which led to the development of the 'SELF-program': a holistic, interactive and theory-based program that aims to improve activity encouragement behavior of nurses and indirectly to optimize self-reliance of nursing home residents. Objective: The aim of this study was to examine the effectiveness of the SELF-program on nurses' activity encouragement behavior and nursing home residents' self-reliance in activities of daily living. Method: The program's effectiveness was examined in a two-arm (SELF-program vs Care as Usual) cluster-randomized trial in Dutch nursing homes. Wards were recruited as units of intervention. The MAINtAIN questionnaire was used to assess the primary outcome: nurses' activity encouragement behavior regarding self-reliance in activities of daily living. The GARS-4 questionnaire was used to assess the secondary outcome: residents' self-reliance in activities of daily living. Measurements were taken at: 1) baseline, 2) three months after baseline, and 3) six months (for residents) and nine months (for nurses) after baseline. The acquired data was analyzed using mixed linear regression. Both adjusted and unadjusted analyses are reported. Results: Twenty-eight nursing home wards, with 287 nurses and 241 residents participated in the study. A statistically significant treatment by time interaction effect was observed in nurses' activity encouragement behavior at three months (d = 0.53; p = .003; 95 % CI 1.88-8.02) and at nine months (d = 0.38; p = .02; 95 % CI 0.67-7.27). No statistically significant treatment by time interaction effects were observed in residents' self-reliance in activities of daily living. However, a trend was observed towards a less pronounced decrease in self-reliance in those residents allocated to wards that exposed nurses to the SELF-program, reflected by small to medium negative effect sizes at three months (d = - 0.25; p = .07; 95 % CI -2.21 - 0.09) and at six months (d = - 0.29; p = .07; 95 % CI -3.22 - 0.11). Conclusion: The SELF-program was effective in improving nurses' activity encouragement behavior. The process evaluation conducted parallel to the trial could yield valuable lessons to further improve the SELF-program before widespread implementation. Trial-registration: The study is registered in the Dutch Trial Register (NL9189), as of December 22 2020. Recruitment commenced in March 2021.

Objectives As age increases, people generally start experiencing problems related to independent living, resulting in an increased need for long-term care services. Investing in sustainable solutions to promote independent living is therefore essential. Subsequently, reablement is a concept attracting growing interest. Reablement is a person-centred, holistic approach promoting older adults' active participation through daily, social, leisure and physical activities. The aim of this paper is to describe the development and content of I-MANAGE, a model for a reablement programme for community-dwelling older adults.Design The development of the programme was performed according to the Medical Research Council framework as part of the TRANS-SENIOR international training and research network. A co-creation design was used, including literature research, observations, interviews, and working group sessions with stakeholders.Setting and participants The interviews and working group sessions took place in the Dutch long-term home care context. Stakeholders invited to the individual interviews and working group sessions included care professionals, policymakers, client representatives, informal caregiver representatives, informal caregivers, and scientific experts.Results The co-creation process resulted in a 5-phase interdisciplinary primary care programme, called I-MANAGE. The programme focuses on improving the self-management and well-being of older adults by working towards their meaningful goals. During the programme, the person's physical and social environment will be put to optimal use, and sufficient support will be provided to informal caregivers to reduce their burden. Lastly, the programme aims for continuity of care and better communication and coordination.Conclusion The I-MANAGE programme can be tailored to the local practices and resources and is therefore suitable for the use in different settings, nationally and internationally. If the programme is implemented as described, it is important to closely monitor the process and results.

Despite its frequent provision, evidence of nursing interventions in Activities of Daily Living (ADL) remains unclear. Hence, we addressed the research question: What are the effects of ADL nursing interventions on independence and comfort in adults across all care settings? We conducted a systematic review of randomized controlled trials and quasi-experimental studies described in systematic reviews. In three databases, we searched for systematic reviews that we used as a portal to select (quasi) experimental studies. After narratively summarizing the studies on characteristics, effects, and interventions, we assessed the risk of bias. Among the 31 included studies, 14 studies evaluated independence, 14 studies measured comfort, and three studies assessed both outcomes. Seven interventions significantly improved independence and seven interventions significantly improved comfort. The studies varied highly in intervention components, outcome measures, and quality. Evidence on ADL nursing interventions affecting independence and comfort remains fragmented and inconclusive, limiting guidance for nursing professionals.

INTRODUCTION:Supporting care receivers in Activities of Daily Living (ADL), irrespective of diagnosis, setting, or cultural background, lies at the heart of fundamental nursing care. The pursuit of quality ADL care becomes increasingly challenging with the changing complexity of care needs. ADL care delivery is often undervalued and is considered a low-status task despite its crucial importance to care receivers. This study aims to synthesize challenges in ADL care irrespective of the care setting.METHODS:In the mixed qualitative methods study, we used expert panel consultations, world café sessions, and a rapid literature review. For data analysis, we simultaneously analyzed the three data sets using inductive and deductive inquiry.RESULTS:We identified four challenges and their corresponding subthemes. They are (1) Undervalued common-sense work versus complex, high-skilled care provision; (2) Limitations in professional reflective clinical decision-making; (3) Missed opportunities for shared ADL decisions; and (4) Meeting ADL care needs in a high-throughput system.CONCLUSION:These challenges reveal the complexity of ADL care and how its paradoxical narrative relates to the conditions in which nursing professionals struggle to create opportunities, for reflective clinical reasoning and shared ADL decisions, by facing organizational and environmental barriers.CLINICAL RELEVANCE:This study is relevant to nursing professionals, care organizations, policymakers, and researchers aiming to improve ADL care and provide insights into challenges in ADL care. This study forms the starting point for a changing narrative on ADL nursing care and subsequent quality improvements in the form of, for example, guidelines for nursing professionals.

Abstract Background Care for activities of daily living (ADL) performed by nursing professionals is poorly informed by scientific evidence. To address the nursing professionals’ need for guidance, we developed a clinical practice guideline on ADL care. This guideline comprises key recommendations (KRs) on involving care receivers and informal caregivers in ADL care, identifying ADL care needs, and effective ADL interventions. With the actual guideline use depending on different factors, insight into these influencing factors is necessary prior to the actual implementation. In a pilot implementation, we aimed to measure the use of KRs in various relevant care settings and to identify and explore these influencing factors. Methods In a pilot implementation study, mixed methods were applied where (1) nursing professionals weekly and retrospectively registered the frequency of the used key recommendations in a three-week period; (2) a survey was used to identify impeding and facilitating factors; and (3) focus groups were conducted to explore additional factors and how they influence KR use. Descriptive analysis was performed on registration and survey data, while focus group data was analyzed deductively. Results Seven nursing care teams participated from the hospital (n = 1), rehabilitation (n = 2), home-care (n = 1), and long-term care (n = 3). The use of KRs varied between KRs and across care settings, with the most frequently used KRs being on involving care receivers in ADL related care choices. KRs were least applied to assessing ADL functioning. The survey on factors influencing the implementation showed how the majority of factors across domains and care settings were generally perceived as facilitating, including the inner setting, the innovation itself, and individuals. Impeding factors mainly related to low tension for change and limited personal benefits. Additional constructs addressed in six focus group sessions included innovation characteristics (e.g. procedural clarity) and cooperation with care receivers. Conclusions The KRs generally appear implementable across care settings, with limited factors hindering the KR use. Despite the impression that the KRs are generally perceived as highly compatible with current norms and workflows, low tension for change raises questions on the awareness of current opportunities for improvement in ADL nursing care.