Faculty of Health, Witten/Herdecke University, School of Nursing Science, Witten, Germany.
German Center for Neurodegenerative Diseases, Witten, Germany.
PLoS One. 2021 Nov 16;16(11):e0259496. doi: 10.1371/journal.pone.0259496. eCollection 2021.
Dementia special care units represent a widely implemented care model in nursing homes. Their benefits must be thoroughly evaluated given the risk of exclusion and stigma. The aim of this study is to present an initial programme theory that follows the principles of realist methodology. The theory development was guided by the question of the mechanisms at play in the context of dementia special care units to produce or influence outcomes of interest in people with dementia.
The initial programme theory is based on qualitative interviews with dementia special care stakeholders in Germany and a realist review of complex interventions in dementia special care units. The interviews were analysed using content analysis techniques. For the realist review, a systematic literature search was conducted in four scientific databases; studies were appraised for quality and relevance. All data were analysed independently by two researchers. A realist informed logic model was developed, and context-mechanism-outcome (CMO) configurations were described.
We reviewed 16 empirical studies and interviewed 16 stakeholders. In the interviews, contextual factors at the system, organisation and individual levels that influence the provision of care in dementia special care units were discussed. The interviewees described the following four interventions typical of dementia special care units: adaptation to the environment, family and public involvement, provision of activities and behaviour management. With exception of family and public involvement, these interventions were the focus of the reviewed studies. The outcomes of interest of stakeholders include responsive behaviour and quality of life, which were also investigated in the empirical studies. By combining data from interviews and a realist review, we framed three CMO configurations relevant to environment, activity, and behaviour management.
As important contextual factors of dementia special care units, we discuss the transparency of policies to regulate dementia care, segregation and admission policies, purposeful recruitment and education of staff and a good fit between residents and their environment.
痴呆特殊护理单元是养老院中广泛实施的护理模式。鉴于排斥和污名化的风险，必须彻底评估其益处。本研究旨在提出一个遵循现实主义方法论原则的初步方案理论。该理论的发展是基于在痴呆特殊护理单元背景下发挥作用的机制的问题，以产生或影响痴呆患者的相关结果。
初步方案理论是基于德国痴呆特殊护理利益相关者的定性访谈以及对痴呆特殊护理单元中复杂干预措施的现实主义审查。访谈采用内容分析技术进行分析。对于现实主义审查，在四个科学数据库中进行了系统的文献检索；对研究进行了质量和相关性评估。所有数据均由两名研究人员独立分析。开发了一个现实主义的逻辑模型，并描述了情境-机制-结果（CMO）配置。
我们回顾了 16 项实证研究并采访了 16 位利益相关者。在访谈中，讨论了影响痴呆特殊护理单元护理提供的系统、组织和个人层面的背景因素。受访者描述了以下四个痴呆特殊护理单元的典型干预措施：环境适应、家庭和公众参与、活动提供和行为管理。除了家庭和公众参与外，这些干预措施是审查研究的重点。利益相关者关注的结果包括反应性行为和生活质量，这也是实证研究的重点。通过结合访谈和现实主义审查的数据，我们构建了与环境、活动和行为管理相关的三个 CMO 配置。
作为痴呆特殊护理单元的重要背景因素，我们讨论了调节痴呆护理的政策透明度、隔离和入院政策、员工的有目的招聘和教育以及居民与其环境之间的良好匹配。
