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Table 2 Mechanisms of impact of the care concept of the SCU

From: Mechanisms of impact and contextual aspects of a dementia special care unit in long-term care: a process evaluation

Domain Theme Intervention Mechanism Outcome Impact
Interventions focusing on nurses Development of nurses’ skills and knowledge Training team members in validation Shapes the understanding of nursing as well as of dementia and its impact Adjusted care practices towards an adequate response to the needs of residents • Altered prioritisation of care tasks
• Altered time management
Discussion in the team of situations experienced as problematic or challenging by individual nurses Enables team members to reflect their experiences together and express their opinions Creative and innovative solutions for situations experienced as challenging Continuous acquisition of competences of the whole team and continuous improvement in self-efficacy of the whole team (positive reinforcing feedback loops)
Providing all nurses access to the same training Shapes a shared understanding of and competence in care for persons with dementia • Team competence and self-efficacy: the ability and experience of every nurse to react to changing situations
• Shared and consistent approach to care
Flexibility in care
Promotion of a positive work climate Joint discussion of situations experienced as problematic or challenging by individual nurses in the team to jointly find solutions • Promotes a mutual understanding and a feeling of being a valued team member
• Makes the nurses feel not to be left alone with a problem
• Enables the provision of good care, also in situations experienced as challenging
• Positive work climate
• Provision of good dementia care
• Culture of solidarity: nurses are looking out for and support each other
• Promotion of staff retention
• Sustainable implementation of the care concept
Informal and formal team gatherings during and after work Promotes mutual appreciation and team cohesion
Spatial and personnel composition of the unit Adjusted spatial structures Small-scale, household-like units • Are perceived as spaces with a constant but low level of acoustic and visual stimuli
• Facilitate the fulfilment of the needs of engagement in activities and social life as well as withdrawal
• Residents spend most of their time in common areas
• Residents seldom retreat to their bedrooms
• Social engagement
• Engagement in activities
Adjusted personnel deployment strategy – “dedicated time for activities” Extra nursing shift dedicated to promoting activities • Provides nurses with time to promote activities and social interaction
• Conveys nurses the feeling, that the promotion of activities is part of their job
• Establishes an understanding of nursing within the team that includes physical, psychosocial and occupational tasks directed at the individual persons preferences, desires and needs
• Promotion of residents’ engagement in activities and social interaction by nurses of the extra and the “normal” shifts
• Social engagement
• Engagement in activities
Interventions focusing on residents Promotion of relaxationa Personalised psychosocial interventions directed at the individual persons preferences, desires and needs at an early stage of agitation or to prevent agitation or other challenging behaviour • Leads to relaxation of the specific resident • Relaxed, purposeful actions of the specific resident
• Social engagement
• Engagement in activities
• Relaxing, calm, peaceful environment
• Time spent in communal areas
• Work processes of nurses
Promotion of engagement in activities Activities offered by nurses throughout the day personalised in content, type, timing, duration and participation mode (single or group, self-initiated with support from nurses, initiated by nurses with active participation, initiated by nurses with active, supported participation or initiated by nurses with passive participation) • Increases the motivation for participation
• Promotes residents` focus on the activity
• Enables residents to use their resources purposefully
• Enables residents to interact meaningfully with the environment and the people in it
• Time spent on activities
• Positive experiences
• Social engagement
• Relaxation
Promotion of engagement in social interaction • Constant, personalised impulses for the social interaction of nurses and the living in a household-like unit
• Active, appreciative communication with family members
• Promotes spending time together
• Promotes shared experiences
• Promotes social interaction between residents
• Promotes social interaction between residents and nurses
• Makes family members and loved ones feel valued and welcome
• Becoming part of a social community
• Involvement in a fragile, social (sub-)group
• Emotional connections to others
• Relationship with family members and loved ones
• Belonging
• Relaxation
• Affection
  1. a Definition of relaxation: In the interviews, nurses and managers agreed that relaxation was understood as an opposite state of agitation and in distinction from apathy. They recognise relaxation in a low muscle tone, relaxed neck and face muscles, a focused look, the ability to stay calmly at one place, the absence of repetitive movements and intense (negative) feelings and unmet needs. A significant characteristic of relaxation is seen in the contact ability that is described as residents’ ability to react in an adequate way to interactions of others enabling them to communicate with them