Abstract
BackgroundThe implementation of evidence-based interventions for people with dementia is complex and challenging. However, successful implementation might be a key element to ensure evidence-based practice and high quality of care. There is a need to improve implementation processes in dementia care by better understanding the arising challenges. Thus, the aim of this study was to identify recent knowledge concerning barriers and facilitators to implementing nurse-led interventions in dementia care.MethodsWe performed a scoping review using the methodological framework of Arksey and O’Malley. Studies explicitly reporting on the implementation process and factors influencing the implementation of a nurse-led intervention in dementia care in all settings were included. We searched eight databases from January 2015 until January 2019. Two authors independently selected the studies. For data analysis, we used an inductive approach to build domains and categories.ResultsWe included 26 studies in the review and identified barriers as well as facilitators in five domains: policy (e.g. financing issues, health insurance), organisation (e.g. organisational culture and vision, resources, management support), intervention/implementation (e.g. complexity of the intervention, perceived value of the intervention), staff (e.g. knowledge, experience and skills, attitude towards the intervention), and person with dementia/family (e.g. nature and stage of dementia, response of persons with dementia and their families).ConclusionsBesides general influencing factors for implementing nursing interventions, we identified dementia-specific factors reaching beyond already known barriers and facilitators. A pre-existing person-centred culture of care as well as consistent team cultures and attitudes have a facilitating effect on implementation processes. Furthermore, there is a need for interventions that are highly flexible and sensitive to patients’ condition, needs and behaviour.
Highlights
The implementation of evidence-based interventions for people with dementia is complex and challenging
Reviews investigating challenges and influencing factors concerning the implementation of interventions in dementia care are focused on psychosocial interventions in residential dementia care or on personalised dementia care in community settings [8, 10]
The population of interest consisted of people with all types and stages of dementia, relatives of people with dementia and health professionals involved in the implementation process
Summary
The implementation of evidence-based interventions for people with dementia is complex and challenging. The aim of this study was to identify recent knowledge concerning barriers and facilitators to implementing nurse-led interventions in dementia care. In a scoping review addressing implementation strategies as well as related barriers and facilitators in dementia care, Lourida et al [11] identified factors influencing implementation and dissemination activities in dementia care from publications between 1998 and October 2015 They describe the following categories: organisational (e.g. time, workload, leadership) and professional (e.g. knowledge and training), personality and staff characteristics (e.g. engagement, resistance), financial (e.g. funding), environmental (physical structure), legal, resident-specific (health status) and dementia-specific (cognitive impairment and complications in the course of the disease). Barriers summarized in the category issues concerning trial procedure comprise the organisation of the trial, follow-up or supervision periods and communication problems between the study team and staff in clinical practice [23, 24, 32, 36]
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