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