Table 1 Detailed description of the components of the MoNoPol-Sleep intervention to reduce and prevent sleep problems for people with dementia in nursing homes

1.

Assessment of established sleep-promoting interventions and an appropriate environment in the participating nursing homes

▪ This assessment is based on interviews with the nursing staff (from night shifts) and a proxy assessment (via structured observations) of implemented interventions to promote the sleep of people with dementia.

▪ Nursing homes are heterogeneous in terms of the existing prevalence of sleep problems and implemented interventions to avoid or reduce sleep problems [10, 33].

▪ To ensure that the MoNoPol-Sleep intervention can be individually tailored to the needs of the participating nursing home, an assessment will be carried out.

▪ Self-developed structured observation checklist and interview guide (which was already tested and adapted during the intervention development)

▪ Structured feedback as part of intervention component No. 3

▪ Observation on site (participating nursing home) and face to face interviews

▪ Research staff

▪ One proxy assessment (on site observation between 5 p.m. and 2 a.m.) and interviews with a minimum of four nurses (two day shift and two night shift)

▪ First week of the intervention phase

2.

Implementation of two “sleep nurses” as change agents per nursing home.

▪ During the intervention phase, the sleep nurses (one nurse from the day shift and one nurse from the night shift) act as contact persons, multipliers, coordinators, change agents and as implementers of person-centered sleep promotion.

▪ For this purpose, the sleep nurses receive in-depth knowledge about sleep promotion, implementation strategies with regard to the MoNoPol-Sleep interventions and problem-solving strategies.

▪ In addition, the sleep nurses can reflect on their actions in coaching sessions and develop new problem-solving strategies.

▪ Local praxis development champions are a crucial factor to implement person-centered care interventions [34, 35]

▪ Sleep nurses are important as contact persons, change agents and local champions. Such champions are recommended for the implementation of complex interventions [36].

▪ Written education material

▪ Written profile of the sleep nurses

▪ Education sessions (both sleep nurses together for each nursing home)

▪ Coaching sessions (both sleep nurses together for each nursing home)

▪ Research staff

▪ Education: approx. Two hours of education as part of component No. 3

▪ Coaching: approx. One hour after each workshop of the components No. 4 and 5

3.

Basic education course for nursing staff: “Sleep problems in dementia”.

▪ The education session is divided into three parts:

▪ Part 1 aims to provide information on the following topics: information on the background, course, schedule and responsibilities of the MoNoPol-Sleep trial, principles of person-centered care, sleep and sleep problems of people with dementia. Moreover, evidence-based information regarding six strategies to promote sleep of people with dementia will be presented. These strategies are: (1) Activation of people with dementia during the day, (2) Review and, if necessary, adjustment of the “going to bed routine”, (3) Review and, if necessary, adjustment of the night care (e.g. change of position routine), (4) Freedom from symptoms (e.g. with regard to thirst, pain, itching, anxiety), (5) Reflection of the appropriateness of sleep medication (6) Review and, if necessary, adjustment of the sleeping environment (e.g. light, sounds, temperature)

▪ The results of the assessment of established sleep-promoting interventions (component No. 1) will be presented in Part 2.

▪ Part 3 aims to provide information on the function and tasks of the new role of a sleep nurse (component No. 2) as change agent in each nursing home (intervention group).

▪ Information regarding six strategies to promote sleep of people with dementia will be based on three reviews [23, 27, 37].

▪ To give the nursing staff basic information about sleep problems in dementia as well as the schedule of the upcoming interventions.

▪ Sleep nurses need further information to fulfill their new role.

▪ Written education material

▪ Information brochure (component No. 6)

▪ Group session

▪ Research staff

▪ One session divided into three parts:

▪ Part 1 takes approx. 45 min, while Part 2 takes approx. 45 min and Part 3 lasts approx. Two hours

▪ Second week of intervention

4.

Advanced education course for nursing staff: “Tailored problem solving” (two workshops).

▪ Two workshops which aim to support the implementation of person-centered sleep promotion and problem-solving competencies.

▪ In both workshops, one case of a resident with sleep problems from the facility will be discussed and solutions for improved sleep promotion sought.

▪ Each workshop contains the following seven steps: (1) Introduction, (2) Presentation of one resident as a case with sleep problems by the sleep nurse, (3) Prioritizing of care problems by all workshop participants, (4) Information about potential reasons for sleep problems by the moderating researcher, (5) Analysis of potential influencing factors for case-specific sleep problems by all workshop participants, (6) Formation of hypotheses for understanding, (7) Development and consensus on an action plan.

▪ Based on a theory of change which was developed during the MoNoPol-Sleep intervention development: Sleep problems and their causes are individual for each person with dementia.

▪ Nursing home staff needs support in problem solving which take the available resources of people with dementia and the care environment into account.

▪ The seven steps of the workshop are based on the available knowledge for conducting case conferences [38,39,40].

▪ Direction plan for the workshop

▪ Digital presentation

▪ Written education material

▪ Self-developed, standardized case analysis chart

▪ Moderator manual including e.g. list of causes for sleep problems, list of symptoms of sleep problems)

▪ Group sessions

▪ Research staff

▪ Sleep nurses

▪ Both workshops take approx. 1.5 h each

▪ The first workshop will be held after component No. 3 and by the 6th week of intervention at the latest

▪ The second workshop will be held between the 7th and 12th week of intervention

5.

Workshops: “Development of an institutional sleep-promoting concept” (two workshops with nursing management and sleep nurses).

▪ Two workshops aimed at the development and implementation of an organizational, specific action plan to promote sleep.

▪ The first workshop contains the following four steps: (1) Introduction, (2) Knowledge refreshment regarding the results of the assessment of established sleep-promoting interventions (component No. 1) and six strategies to promote sleep of people with dementia (see component No. 3), (3) Identification of organizational structures and processes which promote or hinder the sleep promotion, (4) Development and consensus on an action plan.

▪ The second workshop contains three steps: (1) Introduction, (2) Identification of organizational structures and processes which promote or hinder the implementation of the action plan (workshop 1), (3) Development and consensus on the implementation of the action plan.

▪ Based on a theory of change which was developed during the MoNoPol-Sleep intervention development: Nursing homes are heterogeneous in terms of opportunities to provide person-centered sleep promotion.

▪ Self-developed, standardized workshop protocol including resources for the moderator (e.g. action plan form)

▪ Group sessions

▪ Research staff

▪ Sleep nurses

▪ Both workshops take approx. 2.5 h each

▪ The first workshop will be held after component No. 3 and by the 6th week of intervention at the latest

▪ The second workshop will be held between the 7th and 12th week of intervention

6.

Written information and education material (e.g. brochure and “One Minute Wonder” poster).

▪ A series of eight “One Minute Wonder” posters addressing restful sleep, the identification of sleep problems and six strategies to promote sleep of people with dementia (see component No. 3).

▪ Two individual nursing home “One Minute Wonder” posters which will contain the nursing home’s specific action plan and its implementation (component No. 5).

▪ Information brochure which contains evidence-based information on sleep and sleep problems of people with dementia, six strategies to promote sleep of people with dementia (see component No. 3) and education material.

▪ See components No. 1 to 5

▪ “One Minute Wonder” poster

▪ Information brochure

▪ Not applicable

▪ Research staff

▪ Each ward of the participating nursing homes will receive the poster in weekly rhythm

▪ The first posters of the series are distributed on the wards after the basic education course (component No. 3)

▪ After completion of the basic education course, the staff of the nursing home will receive a brochure