scholarly journals Types of implementation of the dementia-specific case conference concept WELCOME-IdA in nursing homes: a qualitative process evaluation of the FallDem effectiveness trial

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Sonja Teupen ◽  
Daniela Holle ◽  
Martina Roes
Keyword(s):  
Nursing Homes ◽  
Process Evaluation ◽  
Challenging Behavior ◽  
Unintended Consequences ◽  
Case Conference ◽  
Effectiveness Trial ◽  
People With Dementia ◽  
Custom Made ◽  
Case Conferences ◽  
Qualitative Process Evaluation

Abstract Background Dementia is regularly associated with behavioral and psychological symptoms of dementia (BPSD, also referred to as challenging behavior). Structured dementia-specific case conferences (DSCCs) enable nursing staff in nursing homes (NHs) to analyze and handle the BPSD of residents with dementia. The FallDem trial estimated the effectiveness of the structured DSCC intervention WELCOME-IdA (Wittener model of case conferences for people with dementia – the Innovative dementia-oriented Assessment tool) in NHs in Germany. No significant change in the overall prevalence of challenging behavior was found. A multipart process evaluation was conducted to explain this result. Methods This qualitative process evaluation of the response of individuals, perceived maintenance, effectiveness, and unintended consequences was part of the multipart process evaluation that followed the framework by Grant et al. (Trials 14: 15, 2013). It used the data from semi-structured telephone interviews and focus group interviews with nurses and managers as secondary data. Selected domains of the Consolidated Framework for Implementation Research (CFIR) were used as deductive categories for a directed content analysis. Results The interviewees in all NHs appraised WELCOME-IdA as generating positive change, although it proved important that some adjustments were made to the intervention and the organization. Thirteen CFIR constructs out of the domains intervention characteristics, inner setting, and process proved to be essential for understanding the different course that the implementation of WELCOME-IdA took in each of the four NHs. This is reflected in three types of WELCOME-IdA implementation: (1) priority on adjusting the intervention to fit the organization, (2) priority on adjusting the organization to fit the intervention, and (3) no setting of priorities in adjusting either the organization or the intervention. Conclusion The unsatisfying results of the FallDem effectiveness trial can in part be explained with regard to the interplay between the intervention and the implementation which was revealed in the processes that occurred in the organizations during the implementation of the WELCOME-IdA intervention. Future implementation of WELCOME-IdA should be tailored based on an analysis of the organization’s readiness, resources, and capacities and should also define custom-made intervention and implementation outcomes to measure success. Furthermore, our results confirm that the CFIR can be used beneficially to conduct process evaluations.

Case conferences as interventions dealing with the challenging behavior of people with dementia in nursing homes: a systematic review

2012 ◽  
Vol 24 (12) ◽  
pp. 1891-1903 ◽  
Author(s):  
Sven Reuther ◽  
Martin Nikolaus Dichter ◽  
Ines Buscher ◽  
Horst Christian Vollmar ◽  
Daniela Holle ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Challenging Behavior ◽  
Intervention Studies ◽  
Challenging Behaviors ◽  
Cochrane Library ◽  
Case Conference ◽  
Positive Effects ◽  
People With Dementia ◽  
Case Conferences

ABSTRACTBackground: Challenging behaviors such as aggression, screaming, and apathy are often encountered when caring for people with dementia in nursing homes. In this context, a case conference is often recommended for healthcare professionals as an effective instrument to improve the quality of care. However, the subject case conference has not had great consideration in scientific literature. The aim of this review is to describe the effects of case conferences on people with dementia and challenging behavior and the staff in nursing homes.Methods: A search of intervention studies in nursing homes in the German or English language was performed in the following databases: Medline, Cinahl, PsycINFO, Cochrane library, Embase, and Google Scholar. The selection and the methodological quality of the studies were assessed independently by two authors. The results were summarized and compared based on categories such as study quality or outcomes.Results: Seven of 432 studies were included in the review. A total of four of seven studies showed a reduction in the challenging behavior of people with dementia, and five showed an influence on the competence, attitudes, and job satisfaction of the staff. However, due to the middle-range quality of several studies, the methodological heterogeneity and differences in the interventions, the results must be interpreted with caution.Conclusions: In summary, little evidence exists for the positive effects of case conferences in the care of people with dementia. This review highlights the need for methodologically well-designed intervention studies to provide conclusive evidence of the effects of case conferences.

Learning from the introduction of ‘skill-mix’ changes in general practice: a qualitative process evaluation

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696701
Author(s):  
Pauline Nelson ◽  
Anne-Marie Martindale ◽  
Anne McBride ◽  
Damian Hodgson
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Process Evaluation ◽  
Unintended Consequences ◽  
Active Management ◽  
Early Adopter ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Skill Mix ◽  
Qualitative Process Evaluation

Background‘Skill-mix’ change (changing mix of staff roles or introducing new ways of working) is increasingly promoted to relieve pressure in general practice teams. As part of a primary care workforce strategy, one locality in Greater Manchester is seeking to integrate three ‘non-medical’ roles – Advanced Practitioners (APs), Physician Associates (PAs) and Clinical Pharmacists (CPs) – to work alongside practice staff.AimA qualitative process evaluation studied the integration of these roles to: establish the aims and priorities of the new services; understand and compare the ways in which the roles are being established with identification of measurable impacts and unintended consequences.MethodA rapid scoping review of the primary care skill-mix literature was conducted to inform the evaluation. Purposive and ‘snowball’ sampling enabled semi-structured interviews (12) and focus groups (2) to be conducted with 27 key individuals (workforce/training leads for the new services; APs/PAs/CPs; GPs/practice managers), before being transcribed, anonymised and analysed thematically with a combination of a priori and grounded codes. Analysis of relevant service/training plans supplemented interview/focus group data.ResultsA number of organisational and operational factors affecting implementation success in early adopter sites were identified including: the intended scope and function of new roles with corresponding implications for measuring impacts; leadership/active management of workforce changes; appropriate training and education; inter-professional tensions; regulatory provisions, and sustainability.ConclusionThere is variation in how the three skill-mix initiatives are being implemented in early adopter sites, with implications for success. Key considerations for introducing skill-mix changes in general practice are being identified.

scholarly journals Nurses’ burden caused by sleep disturbances of nursing home residents with dementia: multicenter cross-sectional study

BMC Nursing ◽  
2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Denise Wilfling ◽  
Martin N. Dichter ◽  
Diana Trutschel ◽  
Sascha Köpke
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Challenging Behavior ◽  
Sleep Disturbances ◽  
Nursing Home Residents ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
People With Dementia ◽  
Total Burden

Abstract Background Sleep disturbances are common in people with dementia. In nursing homes, this is frequently associated with residents’ challenging behavior and potentially with nurses’ burden. This study examined nurses’ burden associated with nursing home residents’ sleep disturbances. Methods A multicenter cross-sectional study was conducted. Nurses’ burden associated with residents’ sleep disturbances was assessed using the Sleep Disorder Inventory (SDI). Additionally, the proportion of nurses’ total burden associated with sleep disturbances of residents with dementia was assessed. A linear mixed regression model was used to investigate the association with nurses’, residents’ and institutional characteristics. Results One hundred eleven nurses from 38 nursing homes were included. 78.4% stated to be regularly confronted with residents’ sleep disturbances during nightshifts, causing distress. The mean proportion of nurses‘ total burden caused by residents‘ sleep disturbances was 23.1 % (SD 18.1). None of the investigated characteristics were significantly associated with nurses’ total burden. Conclusions Nurses report burden associated with sleep disturbances as common problem. There is a need to develop effective interventions for sleep problems and to train nurses how to deal with residents’ sleep disturbances.

scholarly journals Process evaluation of the response of nursing homes to the implementation of the dementia-specific case conference concept WELCOME-IdA: A qualitative study

BMC Nursing ◽  
2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Daniela Holle ◽  
Sonja Teupen ◽  
Rabea Graf ◽  
Rene Müller-Widmer ◽  
Sven Reuther ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Qualitative Study ◽  
Process Evaluation ◽  
Case Conference

scholarly journals Translation and Linguistic Validation of the German Challenging Behavior Scale for Formal Caregivers of People With Dementia in Nursing Homes

2018 ◽  
Vol 26 (3) ◽  
pp. 544-565
Author(s):  
Daniela Holle ◽  
Lena Köller ◽  
Esme Moniz-Cook ◽  
Margareta Halek
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Psychometric Properties ◽  
Content Validity ◽  
Challenging Behavior ◽  
German Version ◽  
Linguistic Validation ◽  
Formal Caregivers ◽  
People With Dementia ◽  
Behavior Scale

Background and Purpose: The Challenging Behavior Scale (CBS) measures the behavior of individuals with dementia. The study aims to translate the English CBS into German (CBS-G) and test its linguistic validity. Methods: The two-panel approach was used to translate the CBS. Nursing home staff reviewed the unambiguity and familiarity of the CBS-G items and the adequateness of the examples used to describe the items. Content validity indexes (CVI) and modified kappa (k) coefficients were calculated. Results: Most of the CBS-G items had excellent CVI and k values for both unambiguity and familiarity. All examples were viewed as adequate. Conclusion: A German version of the CBS that is linguistically equivalent to the original CBS is available but needs further testing of its psychometric properties.

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