Article
Facilitators and barriers to implement nurse-led interventions in long-term dementia care: a scoping review and qualitative study
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Authors
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Julian Hirt
- Eastern Switzerland University of Applied Sciences (formerly FHS St. Gallen), Center for Dementia Care, Institute of Applied Nursing Sciences, Department of Health, St. Gallen, Switzerland; Martin Luther University Halle-Wittenberg, International Graduate Academy, Institute for Health and Nursing Science, Medical Faculty, Halle (Saale), Germany
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Melanie Karrer
- Eastern Switzerland University of Applied Sciences (formerly FHS St. Gallen), Center for Dementia Care, Institute of Applied Nursing Sciences, Department of Health, St. Gallen, Switzerland
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Laura Adlbrecht
- Eastern Switzerland University of Applied Sciences (formerly FHS St. Gallen), Center for Dementia Care, Institute of Applied Nursing Sciences, Department of Health, St. Gallen, Switzerland
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Susi Saxer
- Eastern Switzerland University of Applied Sciences (formerly FHS St. Gallen), Center for Dementia Care, Institute of Applied Nursing Sciences, Department of Health, St. Gallen, Switzerland
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Adelheid Zeller
- Eastern Switzerland University of Applied Sciences (formerly FHS St. Gallen), Center for Dementia Care, Institute of Applied Nursing Sciences, Department of Health, St. Gallen, Switzerland
| Published: | September 27, 2021 |
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Outline
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Background and status of (inter)national research: To ensure high quality of dementia care, the successful implementation of evidence-based interventions is regarded as a key element. However, evidence-basing is associated with certain challenges. To improve the implementation processes, these challenges should be identified. General factors influencing the implementation of nurse-led interventions are known but detailed information is missing.
Question and objective: Our aim was to identify factors influencing the implementation of nurse-led interventions in dementia care. Additionally, we intended to describe experiences and opinions of nursing experts and managers concerning successful implementation.
Method or hypothesis: First, we conducted a scoping review including studies evaluating the implementation process of nurse-led interventions in dementia care. Eight databases were searched for journal articles in English and German. We built domains and categories using an inductive approach. Second, we conducted a qualitative study using individual interviews based on vignettes as a narrative stimulus. The study took place in nursing homes of German-speaking Switzerland and of the Principality of Liechtenstein using purposive sampling. We analysed data thematically following Braun and Clarke.
Results: We included 26 studies in our scoping review and identified influencing factors related to five domains:
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- financing issues,
- 2.
- organisational culture and vision,
- 3.
- complexity of the intervention,
- 4.
- knowledge, experience and skills of staff as well as
- 5.
- the nature of dementia.
In our qualitative study, six dyads of nursing home managers and nursing experts from six nursing homes took part. Our thematic analysis yielded seven themes reflecting influencing factors for a successful implementation of nurse-led interventions in long-term dementia care:
- 1.
- a common attitude and cohesion within the organization,
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- commitment on several levels,
- 3.
- needs-oriented implementation,
- 4.
- effect and public perception of the intervention,
- 5.
- a structured and guided implementation process,
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- knowledge and competencies, as well as
- 7.
- resources for implementing the intervention.
Discussion: Our results expand the evidence concerning influencing factors to implement nurse-led interventions in dementia care.
Practical implications: To support the implementation of nurse-led interventions in long-term dementia care, active commitment-building seems essential. It is the precondition to reach the persons involved, such as nursing home managers, nursing staff, residents, and relatives. In addition, nurses should precisely inform about the intervention. It is necessary that the value of the intervention is perceptible. In addition, nurses should adjust the interventions to the situational needs of people with dementia. Therefore, it is important to support dementia-specific competencies in long-term care.
Appeal for practice (science and/or care) in one sentence: Our results support researchers to implement nurse-led interventions in long-term dementia care by providing in-depth information about influencing factors.
