TY - JOUR
T1 - Mechanisms of impact and contextual aspects of a dementia special care unit in long-term care
T2 - a process evaluation
AU - Adlbrecht, Laura
AU - Bartholomeyczik, Sabine
AU - Mayer, Hanna
N1 - Funding Information:
The study was funded by SeneCura, the nursing home operator of the participating nursing homes in the study.
Funding Information:
We would like to thank all the staff members and managers at the study sites who gave valuable time effort to participate in the study, to support the co-ordination of data-collection and who have shared their insights with us. We thank Tamara Nemeth (TN), a nursing scientist, for her support with data collection. We would also like to thank Mareike Hechinger and Carola Maurer, two nursing scientists, who discussed data and its interpretation critically with us during analytical sessions and thereby enhanced our reflection process.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/12/7
Y1 - 2021/12/7
N2 - BACKGROUND: In long-term care, persons with dementia are often cared for in specialised facilities, which are rather heterogeneous in regard to care concepts. Little information is available on how these facilities and care concepts bring about changes in the targeted outcomes. Such knowledge is needed to understand the effects of care concepts and to consciously shape further developments. This study aimed to explore the mechanisms of impact of a specific care concept from a dementia special care unit and the contextual aspects that influence its implementation or outcomes.METHODS: Using a qualitative approach to process evaluation of complex interventions, we conducted participating observations and focus groups with nurses and single interviews with ward and nursing home managers. Data were collected from two identical dementia special care units to enhance the contrasts in the analysis of two non-specialised nursing homes. We analysed the data thematically. We conducted 16 observations, three group interviews and eleven individual interviews.RESULTS: We identified seven themes in three domains related to mechanisms that lead to outcomes regarding residents' and nurses' behaviour and well-being. The themes include the development of nurses' skills and knowledge, the promotion of a positive work climate, adjusted spatial structures, adjusted personnel deployment strategy "dedicated time for activities", promotion of relaxation, of engagement in activities and of engagement in social interaction of residents. The implementation and outcomes of the care concept are influenced by contextual aspects relating to the (target) population and cultural, organisational and financial features.CONCLUSIONS: The study found expected and unexpected mechanisms of impact and contextual aspects. The care concept of the dementia special care unit results in higher levels of relaxation, activities, and social interaction of residents. Its implementation highly depends on the shared understanding of nursing and the skills of the nursing team. Changes in residents' characteristics result in altered effects of the concept.TRIAL REGISTRATION: DRKS00011513 .
AB - BACKGROUND: In long-term care, persons with dementia are often cared for in specialised facilities, which are rather heterogeneous in regard to care concepts. Little information is available on how these facilities and care concepts bring about changes in the targeted outcomes. Such knowledge is needed to understand the effects of care concepts and to consciously shape further developments. This study aimed to explore the mechanisms of impact of a specific care concept from a dementia special care unit and the contextual aspects that influence its implementation or outcomes.METHODS: Using a qualitative approach to process evaluation of complex interventions, we conducted participating observations and focus groups with nurses and single interviews with ward and nursing home managers. Data were collected from two identical dementia special care units to enhance the contrasts in the analysis of two non-specialised nursing homes. We analysed the data thematically. We conducted 16 observations, three group interviews and eleven individual interviews.RESULTS: We identified seven themes in three domains related to mechanisms that lead to outcomes regarding residents' and nurses' behaviour and well-being. The themes include the development of nurses' skills and knowledge, the promotion of a positive work climate, adjusted spatial structures, adjusted personnel deployment strategy "dedicated time for activities", promotion of relaxation, of engagement in activities and of engagement in social interaction of residents. The implementation and outcomes of the care concept are influenced by contextual aspects relating to the (target) population and cultural, organisational and financial features.CONCLUSIONS: The study found expected and unexpected mechanisms of impact and contextual aspects. The care concept of the dementia special care unit results in higher levels of relaxation, activities, and social interaction of residents. Its implementation highly depends on the shared understanding of nursing and the skills of the nursing team. Changes in residents' characteristics result in altered effects of the concept.TRIAL REGISTRATION: DRKS00011513 .
KW - Dementia/diagnosis
KW - Focus Groups
KW - Humans
KW - Long-Term Care
KW - Nursing Homes
UR - http://www.scopus.com/inward/record.url?scp=85120879676&partnerID=8YFLogxK
U2 - 10.1186/s12877-021-02637-5
DO - 10.1186/s12877-021-02637-5
M3 - Journal article
C2 - 34876048
SN - 1471-2318
VL - 21
SP - 680
JO - BMC Geriatrics
JF - BMC Geriatrics
IS - 1
M1 - 680
ER -