Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2024

Open Access 01-12-2024 | Dementia | Research

Implementing a new living concept for persons with dementia in long-term care: evaluation of a quality improvement process

Authors: Suzanne Portegijs, Adriana Petronella Anna van Beek, Lilian Huibertina Davida van Tuyl, Cordula Wagner

Published in: BMC Health Services Research | Issue 1/2024

Login to get access

Abstract

Background

Improving quality of nursing home care for residents is a constant focus of stakeholders involved within quality improvement projects. Though, achieving change in long-term care is challenging. Process evaluations provide insight into the nature, exposure and experiences of stakeholders and influencing mechanisms for implementation. The aim of this study is to gain insight into the process and facilitating and hindering mechanisms of implementing a quality improvement project that seeks to create a dementia-friendly community with a nursing home at its core.

Methods

For the process evaluation we planned a case study design with an ethnographic approach. Various research methods were used: qualitative observations, focus groups, interviews and questionnaires for various stakeholders and document review. Data collection and analyses in this study is based on the Consolidated Framework for Implementation Research.

Results

Four main lessons were learned. Firstly, nursing staff are crucial to achieve more freedom for residents. Secondly, high-impact changes in daily care need strong and sustainable focus from the care organisation. Thirdly, dementia-friendly societies should be deployed from multiple actors, which entails long-term collaborations with external stakeholders. Fourthly, the transition to a dementia-friendly society requires meeting spaces for and a focus on both residents and people from the community. Consequently, local residents are shifting from external to internal stakeholders, extending beyond the regular involvement of informal carers and volunteers within the nursing home.

Conclusions

Nursing homes are part of the local community and provide opportunities to collaborate on a dementia-friendly society. However, the change that is required (promoting freedom, residents’ autonomy and the redesign of care processes) is complex and influenced by various mechanisms. Understanding these mechanisms can benefit other care organisations that strive to implement a similar initiative.
Appendix
Available only for authorised users
Literature
1.
Schroeder P. Using the PDCA cycle. Nurs Qual Connect. 1992;2(1):1, 8.PubMed
2.
3.
Jeurissen P, van Ginneken E. The Dutch health system in 2019: Many major reforms, but still work in progress. Health Policy. 2019;123(3):249–51.PubMedCrossRef
4.
Maarse JA, Jeurissen PP. The policy and politics of the 2015 long-term care reform in the Netherlands. Health Policy. 2016;120(3):241–5.PubMedCrossRef
5.
Low LF, Fletcher J, Goodenough B, Jeon YH, Etherton-Beer C, MacAndrew M, et al. A Systematic Review of Interventions to Change Staff Care Practices in Order to Improve Resident Outcomes in Nursing Homes. PLoS ONE. 2015;10(11):e0140711.PubMedPubMedCentralCrossRef
6.
Zwijsen SA, Smalbrugge M, Eefsting JA, Gerritsen DL, Hertogh CM, Pot AM. Grip on challenging behavior: process evaluation of the implementation of a care program. Trials. 2014;15:302.PubMedPubMedCentralCrossRef
7.
Portegijs S, van Beek APA, van Tuyl LHD, Wagner C. “We usually choose safety over freedom”: results from focus groups with professional caregivers in long-term dementia care. BMC Health Serv Res. 2022;22(1):677.PubMedPubMedCentralCrossRef
8.
Boersma P, van Weert JC, Lakerveld J, Dröes RM. The art of successful implementation of psychosocial interventions in residential dementia care: a systematic review of the literature based on the RE-AIM framework. Int Psychogeriatr. 2015;27(1):19–35.PubMedCrossRef
9.
Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50.PubMedPubMedCentralCrossRef
10.
Hung L, Hudson A, Gregorio M, Jackson L, Mann J, Horne N, et al. Creating Dementia-Friendly Communities for Social Inclusion: A Scoping Review. Gerontol Geriatr Med. 2021;7:23337214211013596.PubMedPubMedCentralCrossRef
11.
Geertz C. The Interpretation of cultures: Basic Books. New York: Basic Books, Inc. Publishers; 1973.
12.
Gertner AK, Franklin J, Roth I, Cruden GH, Haley AD, Finley EP, Hamilton AB, Palinkas LA, Powell BJ. A scoping review of the use of ethnographic approaches in implementation research and recommendations for reporting. Implement Res Pract. 2021;2.
13.
Leslie M, Paradis E, Gropper MA, Reeves S, Kitto S. Applying ethnography to the study of context in healthcare quality and safety. BMJ Qual Saf. 2014;23(2):99–105.PubMedCrossRef
14.
de Boer B, Beerens HC, Katterbach MA, Viduka M, Willemse BM, Verbeek H. The Physical Environment of Nursing Homes for People with Dementia: Traditional Nursing Homes, Small-Scale Living Facilities, and Green Care Farms. Healthcare (Basel). 2018;6(4):137.PubMedPubMedCentralCrossRef
15.
Portegijs S, van Beek S, van Tuyl LHD, Wagner C. Physical Activity in People With Dementia Living in Long-Term Care Facilities and the Connection With Environmental Factors and Behavior. J Aging Phys Act. 2022;31(2):214–22.PubMedCrossRef
16.
Boumans J, van Boekel LC, Verbiest ME, Baan CA, Luijkx KG. Exploring how residential care facilities can enhance the autonomy of people with dementia and improve informal care. Dementia (London). 2022;21(1):136–52.PubMedCrossRef
17.
Lange DJ, Willemse B, Smit D, Pot A. Monitor Woonvormen Dementie tien factoren voor een succesvolle woonvoorziening voor mensen met dementie. Utrecht: Trimbos Instituut; 2011.
18.
Schot vdA, Prins M, Hartstra E, Erp vJ, Stobbe E, Overbeek A, et al. Trends in de verpleeghuiszorg voor mensen met dementie; Monitor Woonvormen Dementie 2008–2020. Utrecht: Trimbos Instituut; 2020.
19.
van den Berg MEL, Winsall M, Dyer SM, Breen F, Gresham M, Crotty M. Understanding the Barriers and Enablers to Using Outdoor Spaces in Nursing Homes: A Systematic Review. Gerontologist. 2020;60(4):e254–69.PubMedCrossRef
20.
Scherder EJ, Bogen T, Eggermont LH, Hamers JP, Swaab DF. The more physical inactivity, the more agitation in dementia. Int Psychogeriatr. 2010;22(8):1203–8.PubMedCrossRef
21.
Steels S. Key characteristics of age-friendly cities and communities: A review. Cities. 2015;47:45–52.CrossRef
22.
Shannon K, Bail K, Neville S. Dementia-friendly community initiatives: An integrative review. J Clin Nurs. 2019;28(11–12):2035–45.PubMedCrossRef
23.
Francke A, van der Heide I, de Bruijn S, Gijsen R, Poos R, Veerbeek M, et al. Een samenhangend beeld van dementie en dementiezorg: kerncijfers, behoeften, zorgaanbod en impact. Utrecht: Netherlands Institute for Health Services Research; 2018.
24.
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.PubMedCrossRef
25.
Yazan B. Three Approaches to Case Study Methods in Education: Yin, Merriam, and Stake. The Qualitative Report. 2015;20:134–52.
26.
Carpiano RM. Come take a walk with me: the “go-along” interview as a novel method for studying the implications of place for health and well-being. Health Place. 2009;15(1):263–72.PubMedCrossRef
27.
van Beek APA. Social networks of nursing staff and organizational performance. A study in long-term care facilities. 2013.
28.
Rantz MJ, Mehr DR, Popejoy L, Zwygart-Stauffacher M, Hicks LL, Grando V, et al. Nursing home care quality: a multidimensional theoretical model. Journal of nursing care quality. 1998;12(3):30–46 quiz 69–70.PubMedCrossRef
29.
van Haeften-van Dijk AM, Meiland FJ, van Mierlo LD, Dröes RM. Transforming nursing home-based day care for people with dementia into socially integrated community day care: process analysis of the transition of six day care centres. Int J Nurs Stud. 2015;52(8):1310–22.PubMedCrossRef
30.
Pronovost PJ. Navigating adaptive challenges in quality improvement. BMJ Qual Saf. 2011;20(7):560–3.PubMedCrossRef
31.
Rosteius K, de Boer B, Staudacher S, Schols J, Verbeek H. How the interrelated physical, social and organisational environment impacts daily life of residents with dementia on a Green Care Farm. Front Public Health. 2022;10:946962.PubMedPubMedCentralCrossRef
32.
Buist Y, Verbeek H, de Boer B, de Bruin SR. Innovating dementia care; implementing characteristics of green care farms in other long-term care settings. Int Psychogeriatr. 2018;30(7):1057–68.PubMedCrossRef
33.
Robinson L, Hutchings D, Corner L, Finch T, Hughes J, Brittain K, et al. Balancing rights and risks: Conflicting perspectives in the management of wandering in dementia. Health Risk & Society - HEALTH RISK SOC. 2007;9:389–406.CrossRef
34.
Koren MJ. Person-centered care for nursing home residents: the culture-change movement. Health affairs (Project Hope). 2010;29(2):312–7.PubMedCrossRef
35.
Lam HR, Chow S, Taylor K, Chow R, Lam H, Bonin K, et al. Challenges of conducting research in long-term care facilities: a systematic review. BMC Geriatr. 2018;18(1):242.PubMedPubMedCentralCrossRef
36.
Coffey A, Hartigan I, Timmons S, Buckley C, Lehane E, O’Loughlin C, et al. Implementation of evidence-based guidance for dementia palliative care using participatory action research: examining implementation through the Consolidated Framework for Implementation Research (CFIR). Implement Sci Commun. 2021;2(1):137.PubMedPubMedCentralCrossRef
37.
WHO. Creating age-friendly environments in Europe: a tool for local policy-makers and planners. 2018. Report No.: ISBN: 9789289052122. WHO/EURO:2018-1088-40834-55192.
38.
de Rooij AH, Luijkx KG, Spruytte N, Emmerink PM, Schols JM, Declercq AG. Family caregiver perspectives on social relations of elderly residents with dementia in small-scale versus traditional long-term care settings in the Netherlands and Belgium. J Clin Nurs. 2012;21(21–22):3106–16.PubMedCrossRef
39.
Koster L, Nies H. It takes three to tango: An ethnography of triadic involvement of residents, families and nurses in long-term dementia care. Health Expect. 2022;25(1):80–90.PubMedCrossRef
40.
Puurveen G, Baumbusch J, Gandhi P. From Family Involvement to Family Inclusion in Nursing Home Settings: A Critical Interpretive Synthesis. J Fam Nurs. 2018;24(1):60–85.PubMedPubMedCentralCrossRef
41.
Fakha A, de Boer B, van Achterberg T, Hamers J, Verbeek H. Fostering the implementation of transitional care innovations for older persons: prioritizing the influencing key factors using a modified Delphi technique. BMC Geriatr. 2022;22(1):131.PubMedPubMedCentralCrossRef
42.
Gillam J, Davies N, Aworinde J, Yorganci E, Anderson JE, Evans C. Implementation of eHealth to Support Assessment and Decision-making for Residents With Dementia in Long-term Care: Systematic Review. J Med Internet Res. 2022;24(2):e29837.PubMedPubMedCentralCrossRef
43.
Hung L, Mann J, Upreti M. Using the Consolidated Framework for Implementation Research to Foster the Adoption of a New Dementia Education Game During the COVID-19 Pandemic. Gerontologist. 2023;63(3):467–77.PubMedCrossRef
44.
Black GB, van Os S, Machen S, Fulop NJ. Ethnographic research as an evolving method for supporting healthcare improvement skills: a scoping review. BMC Med Res Methodol. 2021;21(1):274.PubMedPubMedCentralCrossRef
45.
Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J. The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci. 2022;17(1):75.PubMedPubMedCentralCrossRef
Metadata
Title
Implementing a new living concept for persons with dementia in long-term care: evaluation of a quality improvement process
Authors
Suzanne Portegijs
Adriana Petronella Anna van Beek
Lilian Huibertina Davida van Tuyl
Cordula Wagner
Publication date
01-12-2024
Publisher
BioMed Central
Keywords
Dementia
Dementia
Published in
BMC Health Services Research / Issue 1/2024
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-024-10765-y

Other articles of this Issue 1/2024

BMC Health Services Research 1/2024 Go to the issue

Research

Triage practices for emergency care delivery: a qualitative study among febrile patients and healthcare workers in a tertiary care hospital in Nepal

Research

Exploring patient safety risk in an emergency ward for substance use through a mixed-method analysis

Research

How an increase in income affects the use of dental care services among a low-income population: evidence from the Finnish basic income experiment

Research

Project ECHO®: a global cross-sectional examination of implementation success

Research

Employees’ experiences of a large-scale implementation in a public care setting: a novel mixed-method approach to content analysis

Research

Increasing and sustaining discharges by noon – a multi-year process improvement project