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

BACKGROUND: In long-term care, persons with dementia are often cared for in specialised facilities, which are rather heterogeneous in regard to care concepts. Little information is available on how these facilities and care concepts bring about changes in the targeted outcomes. Such knowledge is needed to understand the effects of care concepts and to consciously shape further developments. This study aimed to explore the mechanisms of impact of a specific care concept from a dementia special care unit and the contextual aspects that influence its implementation or outcomes. METHODS: Using a qualitative approach to process evaluation of complex interventions, we conducted participating observations and focus groups with nurses and single interviews with ward and nursing home managers. Data were collected from two identical dementia special care units to enhance the contrasts in the analysis of two non-specialised nursing homes. We analysed the data thematically. We conducted 16 observations, three group interviews and eleven individual interviews. RESULTS: We identified seven themes in three domains related to mechanisms that lead to outcomes regarding residents’ and nurses’ behaviour and well-being. The themes include the development of nurses’ skills and knowledge, the promotion of a positive work climate, adjusted spatial structures, adjusted personnel deployment strategy “dedicated time for activities”, promotion of relaxation, of engagement in activities and of engagement in social interaction of residents. The implementation and outcomes of the care concept are influenced by contextual aspects relating to the (target) population and cultural, organisational and financial features. CONCLUSIONS: The study found expected and unexpected mechanisms of impact and contextual aspects. The care concept of the dementia special care unit results in higher levels of relaxation, activities, and social interaction of residents. Its implementation highly depends on the shared understanding of nursing and the skills of the nursing team. Changes in residents’ characteristics result in altered effects of the concept. TRIAL REGISTRATION: DRKS00011513.