实施痴呆症关怀映射在养老院中的障碍和促进因素：来自 DCM™ EPIC 试验过程评估的结果。
Barriers and facilitators to implementing dementia care mapping in care homes: results from the DCM™ EPIC trial process evaluation.
机构信息
Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, LS1 3HE, UK.
Oxford Health NHS Foundation Trust, Oxford, UK.
出版信息
BMC Geriatr. 2019 Feb 8;19(1):37. doi: 10.1186/s12877-019-1045-y.
BACKGROUND
Psychosocial person-centred interventions are considered best practice for addressing complex behaviours and care needs such as agitation and anxiety, and for improving the quality of life of people with dementia in care homes. Dementia Care Mapping (DCM™) is an established practice development tool and process aimed to help care home staff deliver more person-centred care. To date, few studies have evaluated the efficacy of DCM™ and have found mixed results. These results are suggested to be the outcome of intervention implementation, which may be impacted by a range of factors. This study reports the barriers and facilitators to DCM™ implementation in care homes found during the process evaluation conducted as part of a randomized controlled trial.
METHODS
Eighteen of the 31 DCM™ intervention care homes were recruited to participate in the embedded process evaluation. Semi-structured interviews were conducted with 83 participants, comprising care home managers, trained DCM™ users (mappers), expert external mappers, staff members, relatives, and residents.
RESULTS
Barriers and facilitators to DCM™ implementation were found at the mapper level (e.g. motivation and confidence), the DCM™ intervention level (e.g. understanding of DCM™) and the care home level (e.g. staffing issues, manager support). Further barriers caused by the burden of trial participation were also identified (e.g. additional paperwork).
CONCLUSIONS
Implementing DCM™ is complex and a greater consideration of potential barriers and facilitators in planning future studies and in practice could help improve implementation.
TRIAL REGISTRATION
Current Controlled Trials ISRCTN82288852 , registered 16/01/2014.
背景
心理社会以患者为中心的干预措施被认为是解决复杂行为和护理需求（如躁动和焦虑）的最佳实践方法，并且可以提高养老院中痴呆症患者的生活质量。痴呆症关爱映射（DCM）是一种既定的实践发展工具和流程，旨在帮助养老院工作人员提供更以患者为中心的护理。迄今为止，很少有研究评估 DCM 的疗效，并且发现结果喜忧参半。这些结果被认为是干预实施的结果，而干预实施可能受到一系列因素的影响。本研究报告了在作为随机对照试验的一部分进行的过程评估中发现的养老院中实施 DCM 所面临的障碍和促进因素。
方法
从 31 个 DCM 干预养老院中招募了 18 个养老院参与嵌入式过程评估。对 83 名参与者（包括养老院经理、经过培训的 DCM 用户（映射者）、外部专家映射者、工作人员、亲属和居民）进行了半结构化访谈。
结果
在映射者层面（例如动机和信心）、DCM 干预层面（例如对 DCM 的理解）和养老院层面（例如人员配备问题、经理支持）发现了实施 DCM 的障碍和促进因素。还确定了因试验参与而产生的额外障碍（例如额外的文书工作）。
结论
实施 DCM 是复杂的，在规划未来的研究和实践时，更充分地考虑潜在的障碍和促进因素，可能有助于改善实施。
试验注册
当前对照试验 ISRCTN82288852，注册于 2014 年 1 月 16 日。
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