Leading by example: Nursing home staff experiences of what facilitates them to meaningfully engage with residents with advanced dementia

Abstract

Objectives Meaningful connections promote the quality of life of people living with advanced dementia in nursing homes. However, evidence internationally suggests people living with advanced dementia in nursing homes spend the majority of time alone, with little contact with anyone. Frontline care workers are in powerful positions to meaningfully engage with residents, yet research to date has not focused on their experiences. The aim of this study was to explore the experiences of nursing home staff, specifically, what care workers feel enables them to meaningfully engage with residents living with advanced dementia. Methods/Design Semi‐structured interviews were conducted with 21 staff from seven nursing homes. Inductive thematic analysis was used. Results Four themes were important for facilitating care workers to meaningfully engage with residents with advanced dementia: support from managers and nurses, support from experienced care workers, a caring culture and an appropriate physical environment. Conclusion Effective leadership was the key thread that ran throughout. It was evident that meaningfully engaging with residents with advanced dementia was hard, particularly for new or inexperienced care workers. Those with experience (of care work and the residents they cared for), as well as those in formal leadership positions played key roles in facilitating care workers to: perceive it was their role to connect, understand, accept and empathise with residents, understand the importance of getting to know residents' and express their own caring attributes. Future research should focus on empirically testing leadership models that promote meaningful engagement.

Good practice in the provision of care for people living with dementia in nursing homes: a systematic review

“…It addresses a number of themes identified in this systematic review (table 1) and illustrates how these can be implemented into practice. The themes addressed in this vignette include: person-centred care,(14, 28, 35, 40, 41, 44) cultural impact,(28, 42) meaningful engagement,(19, 20) eating and meals,(30, 32) the role of family members,(14, 17, 30, 31, 35, 42) restrictive practices,(25, 26) psychotropic medication,(25, 26) materials,(21) end of life care(31, 33, 36) and staffing. (16, 17, 31, 33, 45) Niamh is the registered provider of a 30-bed purpose-built nursing home facility.…”

“…This vignette provides examples of quality dementia care from a resident’s point of view. It covers the following themes: determinants of quality care (13, 15, 16, 30, 37, 38, 39), outcomes (18, 30, 39), person-centred care (14, 17, 18, 28, 32, 35, 41, 44), cultural impact (28, 42) care planning (17, 29, 39), meaningful engagement (19, 20), eating and meals (30, 32, 46), the role of family members (15, 17, 31), restrictive practices (26, 30, 38), activities (15, 18, 25, 27, 28, 34), materials (21), health care (14, 23, 31, 40), end of life care (31, 33, 36), staffing (16, 17, 24, 31, 33, 42, 45) and staff training (14, 16, 17, 20, 24, 31, 41, 42).…”

“…This vignette provides examples of quality dementia care from a family member’s point of view. It covers the following themes: outcomes (18, 30, 39), person-centred care (14, 17, 18, 28, 32, 35, 41, 44), care planning (17, 29, 39), the role of family members (15, 17, 31), activities (15, 18, 25, 27, 28, 34) and materials (21).…”

Person-attuned musical interactions (PAMI) in dementia care. Complex intervention research for constructing a training manual

“…A caring culture is an environment which promotes relational working and staff well-being, which is carried out with positive attitudes toward dementia and expresses caring values and the ambience of the environment. A caring culture also prioritizes the relationships between residents and staff, teamwork, and input from managers and supervisors ( 20 ). Based on semi-structured interviews with 21 staff members from seven nursing homes, Haunch et al conclude that effective leadership and teamwork is crucial for facilitating staff to understand “their role to connect, understand, accept and empathize with residents, understand the importance of getting to know residents and express their own caring attributes” [( 20 ), p. 11].…”

“…A caring culture also prioritizes the relationships between residents and staff, teamwork, and input from managers and supervisors ( 20 ). Based on semi-structured interviews with 21 staff members from seven nursing homes, Haunch et al conclude that effective leadership and teamwork is crucial for facilitating staff to understand “their role to connect, understand, accept and empathize with residents, understand the importance of getting to know residents and express their own caring attributes” [( 20 ), p. 11]. Nurses play a significant role for the caring culture, yet a systematic review reveals that nurses lack knowledge about dementia and PCC, verbal and non-verbal communication skills, and strategies to manage residents' coexisting behavioral and mental health problems.…”