Developing an effective strategy to implement non‐pharmaceutical interventions amongst residents with dementia in residential care facilities: Caregivers’ perspectives

Abstract

AbstractBackgroundNon‐pharmaceutical interventions based on unfulfilled needs amongst residents with dementia reduce symptoms of agitation, aggression and depression. However, to implement these interventions in daily practice in residential care facilities, caregivers need to (a) analyse resident’s behaviour, (b) recognize unfulfilled needs and (c) apply an individualized non‐pharmaceutical intervention.ObjectivesTo develop an effective strategy for the implementation of such complex approach, insights in caregivers’ perception of barriers and facilitating factors are needed.MethodsA total of thirteen focus group interviews with fifty‐six caregivers from twelve residential care facilities was conducted between October 2019 and February 2020.ResultsDespite a person‐centred vision and culture in residential care facilities, caregivers recognize that dealing with altered behaviour amongst residents with dementia is challenging and that non‐pharmaceutical interventions are seldom used. However caregivers are willing to invest in a team‐based person‐centred approach, different perspectives on priorities in care processes seem to influence the implementation. Participants refer to the importance of an open team culture where safety is guaranteed. An open culture stimulates an attitude of reflection, which is necessary to attune person‐centred care to different perspectives. Therefore the presence of clinical and facilitating leadership is crucial to ensure motivation, a sense of competency, communication, problem‐solving competences, practical organization of non‐pharmaceutical interventions and continuity in care processes. Ward managers and clinical leaders prefer to be supported by an implementation coach who provides education and training to the team members and who facilitates from a neutral perspective moments of intervision on a regular base.ConclusionsCaregivers recognize the presence of a person‐centred vision and culture, team willingness and different perspectives on priorities in care processes as influencing factors for the implementation of non‐pharmaceutical interventions. Strong clinical and facilitating leadership and the availability of an implementation coach may support caregivers in dealing with different perspectives on priorities in care. Implications for clinical practice: An educational package, intervision sessions and a leadership trajectory are recommended elements of strategy to implement non‐pharmaceutical interventions based on unfulfilled needs amongst residents with dementia.