Raphaëlle-Ashley Guerbaai graduated with a BSc (Hons) Nursing Degree from the University of Liverpool, UK in 2010 and decided to continue her university education with a Master of Science in Infectious Disease Control (specializing in Epidemiology and Public Health). She received her MSc in spring of 2012 from the London School of Hygiene and Tropical Medicine after working for 6 months on the epidemiology of septicaemia for the Ministry of Health in Tanzania, East Africa. Subsequently, Raphaëlle worked as a specialist nurse in cardiology intensive care at the University Hospital of Grenoble, France.
Raphaëlle completed her Ph.D. in April 2022 working on the INTERCARE project (Nursing Models for Care in Swiss Nursing Homes: Improving INTERprofessional CARE for Better Residential Outcomes), specializing in implementation science and is part of the Patient Safety and Quality of Care Research Group. Since 2022 she is working as a postdoctoral researcher at the Institute of Nursing Science and has recently been awarded a postdoctoral mobility grant.
Implementation fidelity assesses the degree to which an intervention is delivered as it should be. Little is known about how it acts as a moderator between an intervention and its intended outcome(s) and what elements affect the fidelity trajectory over time. We exemplify the meaning of implementation fidelity in INTERCARE, a nurse-led care model that was implemented in eleven Swiss nursing homes (NHs) with the aim of reducing unplanned hospital transfers. INTERCARE has six core elements that were introduced, among them advance care planning and tools to support inter- and intraprofessional communication.
A mixed-methods design was used, guided by the Conceptual Framework for Implementation Fidelity. Fidelity to INTERCARE’s core components was measured with 44 self-developed items at 4 time points (baseline, 6, 12 months post intervention, 9 months post-intervention end); fidelity scores were calculated for each component and overall. Notes from NH meetings were used to identify moderators affecting the fidelity trajectory over time. Generalized linear mixed models were computed to analyze the quantitative data. Deductive thematic analysis was used for the qualitative analysis. The quantitative and qualitative findings were integrated using triangulation.
A higher overall fidelity score showed a decreasing rate of unplanned hospital transfers post-intervention (OR: 0.65 (CI=0.43-0.99), p=0.047). Higher fidelity score to advance care planning was associated with lower unplanned transfers (OR= 0.24 (CI 0.13-0.44), p= < 0.001) and a lower fidelity score for communication tools (e.g., ISBAR) to higher rates in unplanned transfers (OR= 1.69 (CI 1.30-2.19), p= < 0.003).
High implementation fidelity to INTERCARE was necessary to achieve a reduction in unplanned transfers. In-house physicians with a collaborative approach and staff’s perceived need for nurses working in extended roles, were important factors supporting reaching high fidelity. Further research is needed to understand what supports the effective implementation of single elements.