| Qualitative Article | |
| Purpose statement | The article under review is “Development of a proactive care program (U‐CARE) to preserve physical functioning of frail older people in primary care” by Bleijenberg et al. (2013). Bleijenberg et al. (2013) stated that “the aim of the study was to describe the development process of the U-CARE program in detail, to allow its thorough review and replication” (p. 231). |
| Problem statement | Currently, the care delivery for frail older people is reactive and fragmented. To overcome the challenge, there have been different complex interventions that have been undertaken (Bleijenberg et al., 2013). However, the intervention reports have not provided detailed descriptions and considerations that outline the process of the care programs. The British Medical Research Council formed a framework that can be used for complex interventions such as the U-CARE (Craig et al., 2008). Despite the development of the framework, there have been no extensive studies that have reviewed its application and replication. Thus, this intervention was designed to provide a detailed description of the U-CARE process and its feasibility. |
| Literature Review | The article lacked a literature review section. However, the introduction and background provided the basis for understanding the challenges that relate to the provision of health care to frail older people. In the introduction section, the authors provided succinct information related to reactive and fragmented care. Subsequently, the authors outlined the intervention measures that have been undertaken to ensure that there are proactive strategies and interventions to promote the care of frail older people (Bleijenberg et al., 2013). Therefore, the introduction provided a clear understanding of the problem, the current practices and evidence. In addition, the development process of the U-CARE program was based on a multi-method procedure. One of the steps entailed a review of literature from various databases. Thus, the literature review was used as part of the methodology. |
| Framework or Theoretical Perspective. | The British Medical Research Council formed the theoretical basis for the design of the U-CARE program. According to Craig et al. (2008), theoretical understanding plays a critical role in fostering understanding of how an intervention leads to change. This is important in the identification of the weak links and the process of strengthening them. The framework by The British Medical Research Council is based on the understanding that the development of evaluation of a complex intervention involves several phases. However, it is not a necessity for the phases to be in a linear sequence. The main idea of the framework is that interventions should be tailored to local contexts and should apply insights outlined by the Theory of Complex Adaptive Systems (Datta & Petticrew, 2013). |
| Research questions and hypotheses | Research questions are used to guide a study. The article did not have research questions. However, it had a clear aim of the study based on the theoretical framework that guided the implementation of the intervention program. According to Bleijenberg et al. (2013), “the aim of the study was to describe the development process of the U-CARE program in detail and to allow its thorough review and replication” (p. 231). |
| Variables (dependent & independent) Demographic variables | Demographic variables included patients aged 60 years and above. The biopsychosocial components included urinary inconsistence, hearing loss, mood and depression falls and mobility. |
| Method Appropriateness of Design | The study design entailed the use of the Chronic Care Model (CCM) model. The model was used as the basis for redesigning U CARE practice to enhance the quality of care. The framework for the design was based on the British Medical Research Council in which a biopsychosocial approach and focus on the needs of the patients was used. The application of the design ensured a detailed description of the U-CARE program. This was a shift from other complex interventions trials in which detailed descriptions are not provided. |
| Validity of the research | To ensure the validity of the research, a systematic review of the literature was from trusted databases that store peer-reviewed articles. The development of the U-CARE program relied on expert opinion and practical experiences. In addition, there was obligatory U-CARE training for all registered practice nurses. The integrated approach increased the feasibility of the intervention in clinical practice and enhanced its validity. |
| Efficacy of the study Were questions resolved | The main aim was to describe in detail the U-CARE program. The use of the theoretical framework by The British Medical Research Council and the biopsychosocial approach increased the efficacy of the study. Thus, the intervention achieved its mandate. |
| Legal & Ethical issues Human subject protection IRB | The development of the model inspirited frail and elderly people. The main intervention processes were aimed at improving the care for the elderly. The participating nurses were supposed to tailor the intervention to patients’ preferences. In addition, the care plan used was approved by the patient or the caregiver. Therefore, there were no ethical issues arising from the study. |
| Cultural aspects | The care plan targeted elderly people irrespective of their ethnic orientation. The geriatric care was tailor-made and approved by the patient or the caregiver. This ensured that cultural aspects were accommodated. |
| Sample | The study was based on a multi-method procedure. There each method had its sample. The sample frameworks included the elderly patients, literature in the selected databases, nurses and experts. The sample used for the patients was 27 elderly people aged 60 years and above. 2-3 experts (PhD) were used for each identified geriatric condition, 20 nurses and the literature review entailed 11 systematic reviews. |
| Describe procedures | The development was based on predefined guiding components, which included three steps. They included a frailty assessment, comprehensive geriatric assessment (CGA), and tailor-made evidence intervention. The frailty assessment started with a systematic review of peer-reviewed articles obtained from PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and the Cochrane Library. The literature used must have been published between 2000 and 2010. This ensured that information obtained was based on current practices. The development of the integration was based on the integration of the clinical practice, expert opinion and the systematic literature review. |
| Describe results | The study established that the U-CARE intervention is feasible in clinical practice.90% of nurses and 74% GPS of GPS pointed out that the U-CARE program provided a structured approach to help them in addressing geriatric problems. |
| How results of the research may impact future nursing practice | The study established the application of U-CARE is feasible in the nursing practice. The results present a proactive, structured and integrated approach to the care of the elderly. This is a shift from the reactive and fragmented care that the elderly have been subjected to for a long time (Bleijenberg et al., 2013). Therefore, the results serve as a great step in the identification of a complex intervention that can be applied in the primary care of the elderly. |
| Applies research to student’s nursing practice | The study equips the students in the nursing practice with information based on evidence. The detailed description of the U-CARE prepares the students in advance on complex measures interventions that can be applied to care for frail older people. It fosters the understanding of the complex care intervention, which is critical in the primary care of frail older people. |
References
Bleijenberg, N., Dam, H., Drubbel, I., Numans, M., Wit, N., & Schuurmans, M. (2013). Development of a proactive care program (U‐CARE) to preserve physical functioning of frail older people in primary care. Journal of Nursing Scholarship, 45(3), 230-237.
Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., & Petticrew, M. (2008). Developing and evaluating complex interventions: The new Medical Research Council guidance. British Medical Journal, 337 (7676), 979-983.
Datta, J., & Petticrew, M. (2013). Challenges to evaluating complex interventions: A content analysis of published papers. BMC Public Health, 13(1), 568-571.