Abstract
BackgroundIn 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.MethodsUsing 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.ResultsWe 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.ConclusionsThe 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 registrationDRKS00011513.
Highlights
In long-term care, persons with dementia are often cared for in specialised facilities, which are rather heterogeneous in regard to care concepts
Whereas the majority of persons with dementia living in nursing homes are cared for in non-specialised facilities, an increasing number live in dementia special care units [1]
This study focuses on Special care unit (SCU) with a specific care concept and uses a theory-driven evaluation approach to understand the mechanisms triggered by the interventions and how they bring about changes in outcomes
Summary
In long-term care, persons with dementia are often cared for in specialised facilities, which are rather heterogeneous in regard to care concepts. There is no shared precise definition of dementia special care units (SCUs), an empirical study in Germany found that their main characteristics are a segregative living concept, special qualification in psychogeriatric care and additional funding [8] Often, these aspects are complemented by a specific built environment and activities adopted to the residents’ needs [9]. Substantial research has investigated the impact of SCUs on residents’ functional status, neuropsychiatric symptoms, the use of restraints, psychotropic medications, quality of life, engagement in activities and social interaction [10,11,12,13,14] These outcomes have been studied intensively, little is known about how they are achieved, especially as SCUs vary in their characteristics and interventions provided. It is difficult to comprehend how the care concept influences outcomes; though, understanding this relationship is important to further develop specialised care for persons with dementia
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
