Context, mechanisms and outcomes of dementia special care units: An initial programme theory based on realist methodology

Background 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. Methods 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. Results 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. Discussion 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.

Care Effectiveness and Standards of Dementia Special Care Units for Older Adults with Dementiain Pension Industry

Dementia special care units (D-SCUs) is increasingly becoming the main mode of care for older adults internationally. As little is known about D-SCUs in China, this study aimed to analyze care efficiency and summarize the standards of Chinese D-SCUs.A questionnaire survey and in-depth interviews were conducted between June 2018 and July 2019 in six cities in China. Quantitative data about basic information and care satisfaction were collected from 25 care facilities. Qualitative data about the standards of the D-SCUs were collected fromthree cities that had issued such standards. Data envelopment analysis (DEA) was used to evaluate the care efficiency of D-SCUs, and grounded theory was used to analyze qualitative data.Among the 25 surveyed facilities, 12 had established D-SCUs, of which eight(66.67%) were effective facilities. Thirteen facilities did not establish D-SCUs, of which two(15.38%) were effective facilities.Technical efficiency, pure technical efficiency, and scale efficiency of care facilities with D-SCUs were higher than those of without (P=0.016, P=0.022, and P=0.021, respectively). Standards regarding location, environment, beds, and service items varied among the three cities that had issued standards for D-SCUs.The D-SCU care mode is effective and professional, and can be further promoted in the development of pension industry in China. Further investigation into D-SCUs and related standard is needed.

Optimizing Frontline Networking Between Consultant-Led Neonatal Teams in the West Midlands: A Qualitative Report on the Utility of Modified Simulation Training.

Background: In England neonatal care is delivered within operational delivery networks. Units within these networks are one of three designations (Neonatal Intensive Care, Local-Neonatal or Special-Care Units), based on their ability to care for babies with different degrees of illness or prematurity. With the development of network care-pathways, the most premature and sickest are triaged where possible for delivery in services linked to Neonatal Intensive Care units. This has created anxiety for teams in Local-Neonatal and Special-Care units. Less exposure to sicker babies meant limited opportunities to maintain expertise for when they do unexpectedly deliver at services linked to their own units, and thereafter require transfer for ongoing care, to Neonatal Intensive Care units. Simultaneously, Local-Neonatal and Special-Care teams develop skills in care of the less ill and premature baby which was considered of benefit to all. A need for mutual learning through networking between teams of different designations emerged.Method: An interactive programme, ‘Supporting The Sick Neonate’ was developed in the West Midlands. It focused on equal partnership between unit designations, employing high, medium and low fidelity simulation as the vehicle around which networking between units was centered. Sessions of simulation and debrief were augmented with novel networking time to enable multidirectional learning and understanding of practices. Candidates and facilitators were regarded as participants, spanning different designations. A consultant-focus was adopted to promote long term networking. Qualitative assessment of the programme over four years was captured through -graded and free text surveys.Results: 155 individuals involved in frontline neonatal care participated. 77 were consultants, supported by neonatal trainees, staff grade doctors, clinical fellows, advanced neonatal nurse practitioners and nurses in training. All were invited to participate in the qualitative survey. 79% felt that it was highly relevant; 96% agreed that for consultants this was appropriate adult learning. 98% agreed that consultant training encompassed more than bedside clinical management, including forging communication links between teams. Thematic responses around networking were positive.Conclusion: Simulation augmented with networking time with a consultant-focused model proved successful for networking and shared learning for the Neonatal fraternity in the West Midlands.

Factors Affecting Physical and Mental Fatigue among Female Hospital Nurses: The Korea Nurses’ Health Study

Nurses often experience work-related physical and mental fatigue. This study sought to identify the levels of physical and mental fatigue present among Korean female nurses and discern factors influencing their onset. This cross-sectional study analyzed data from the Korea Nurses’ Health Study (KNHS). A total of 14,839 hospital nurses were assessed by hierarchical regression analysis. The mean scores of physical and mental fatigue were 12.57 and 5.79 points, respectively. After adjusting for confounding variables, the work department had a significant influence on both physical and mental fatigue, that is, nurses working in special care units experienced greater degrees of both physical and mental fatigue than those working in general units. Nurse fatigue is an important consideration to monitor to ensure nurses’ continued wellbeing as well as good patient safety levels. Therefore, it is necessary to establish a strategy to mitigate nursing fatigue while considering the characteristics of specific departments. In nursing practice, the introduction of a counseling program and guarantee of rest time that can alleviate the mental and physical fatigue of nurses working in special care units should be considered.

Profiling Nursing Home Care Specialization Groups

The nursing home (NH) industry has experienced a shift toward care specialization. This study used NH-level panel data from 2011 to 2017 to describe unique care specialization groups in urban areas using latent profile analysis (LPA) (N= 64695, with 12,143 unique NHs). We focused on urban NHs because NHs specialize in care due to competition and memetic pressure, more likely to be the case for urban NHs. To identify care specialization profiles, LPA was applied using different types of specialist staffing levels (physical therapist, occupational therapist, physicians, and dietitians) and the share of special care units aimed at chronic conditions like Alzheimer’s Disease and AIDs. Model diagnostics and information criterion guided selection of the best fitting model. Model stability over time, interpretability of results, and parsimony were also taken into consideration. The final results indicated a 4-profile model fit the underlying data best and the patterns remained comparatively stable over seven years. The 4-classes are uniquely identified as: high use of specialists of all types (3%), moderate use of specialists of all types (7%), mixed use of specialists and special care units (26%), and low specialization use (64%). From 2011 to 2017, the size of the ‘low specialization’ group became smaller, whereas the high and moderate groups grew larger. In addition to describing a clear trend towards increased care specialization, our findings indicated great heterogeneity in NHs’ care specialization patterns in urban areas. Future studies should examine market and organizational characteristics, as well as performance outcomes for different specialization groups.

Activation of 574 new Alzheimer’s special care unit beds in the Metropolitan City of Milan

Issue Dementia is among the main causes of disability and dependency in the elderly. It was defined a public health priority by the WHO. The health and social-care system of the Lombardy region (SSR) plays a key role in implementing assistance and care pathways specifically designed for fragile populations, including those affected by dementia and Alzheimer's disease, its most common form. Description of the Problem The SSR provides residential care options especially conceived for dementia patients, known as Alzheimer's special care units (ASCU). However, waiting lists are concerning, and distribution of these facilities is inconsistent throughout the region. In 2018 there were 981 accredited and SSR-covered ASCU beds in the Metropolitan City of Milan (MCM), translating in 1.26 beds/1000 people aged ≥ 65. With regional legislation (DGR 1046/2018), the SSR proposed activation of new ASCU beds in all territories with less than 2 beds/1000 people aged ≥ 65. The MCM Agency for Health Protection (ATS) thus analyzed the distribution of ASCU beds in afferent districts, defining specific needs for each district. The aim was to fund and activate 574 new ASCU beds homogenously among previously accredited and SSR-covered residential care facilities, reaching the targeted 2 ASCU beds/1000 people aged ≥ 65. Applicant facilities had to respond to specific personnel, technological, therapeutic and structural requirements. Results Preliminary results indicate 29 residential care facilities applied for evaluation in 2019. The ATS received and evaluated all applications. Following site-inspection, 8 facilities were deemed inappropriate. Lessons In 2019, 21 residential care facilities were approved for funding and activation of 558 new ASCU beds. Residual beds will be funded in 2020. Main messages: Activation of new ASCU beds in 2019 and 2020 increased specialized long-term care beds for dementia patients by almost 60%, allowing a more homogenous distribution among MCM districts. Key messages The health and social-care system of the Lombardy region proposed activation of new Alzheimer’s special care units beds in all territories with less than 2 beds/1000 people aged ≥ 65. Activation of 574 new Alzheimer’s special care units beds increased by almost 60%, allowing a more homogenous distribution among Metropolitan City of Milan districts.