What hinders and facilitates the implementation of nurse-led interventions in dementia care? A scoping review

Abstract

Background: The implementation of evidence-based interventions for people with dementia is complex and challenging. However, successful implementation might be a key element to ensure evidence-based practice and high quality of care. There is a need to improve implementation processes in dementia care by better understanding the arising challenges. Thus, the aim of this study was to identify recent knowledge concerning barriers and facilitators to implementing nurse-led interventions in dementia care. Methods: We performed a scoping review using the methodological framework of Arksey and O'Malley. Studies explicitly reporting on the implementation process and factors influencing the implementation of a nurse-led intervention in dementia care in all settings were included. We searched eight databases from January 2015 until January 2019. Two authors independently selected the studies. For data analysis, we used an inductive approach to build domains and categories. Results: We included 26 studies in the review and identified barriers as well as facilitators in five domains: policy (e.g. financing issues, health insurance), organisation (e.g. organisational culture and vision, resources, management support), intervention/implementation (e.g. complexity of the intervention, perceived value of the intervention), staff (e.g. knowledge, experience and skills, attitude towards the intervention), and person with dementia/family (e.g. nature and stage of dementia, response of persons with dementia and their families). Conclusions: Besides general influencing factors for implementing nursing interventions, we identified dementiaspecific factors reaching beyond already known barriers and facilitators. A pre-existing person-centred culture of care as well as consistent team cultures and attitudes have a facilitating effect on implementation processes. Furthermore, there is a need for interventions that are highly flexible and sensitive to patients' condition, needs and behaviour.

Factors influencing the deterioration from cognitive decline of normal aging to dementia among nursing home residents

“…The ability to differentiate between normal aging and neurodegenerative etiology of the brain can contribute significantly to implementing the required management approach in a timely manner and delay additional cognitive decline [ 43 ] or developing dementia. Recognizing dementia-specific factors assists healthcare providers, including nurses, in setting up highly flexible and sensitive interventions, treatments, and protocols to meet patients’ needs in nursing homes [ 44 – 46 ]. Further research should be conducted to address the extent to which we can consider cognitive changes that accompany normal aging and to what extent these changes are related to pathological conditions.…”

Factors Influencing the Deterioration from Cognitive Decline of Normal Aging to Dementia among Nursing Home Residents

“…The ability to differentiate between normal aging and neurodegenerative etiology of the brain can contribute signi cantly to implementing the required management approach in a timely manner and delay additional cognitive decline [38] or developing dementia. Recognizing dementia-speci c factors assists healthcare providers, including nurses, in setting up highly exible and sensitive interventions, treatments, and protocols to meet patients' needs in nursing homes [39][40][41]. Further research should be conducted to address the extent to which we can consider cognitive changes that accompany normal aging and to what extent these changes are related to pathological conditions.…”

Factors Influencing the Deterioration from Cognitive Decline of Normal Aging to Dementia among Nursing Home Residents

“…The ability to differentiate between normal aging and neurodegenerative etiology of the brain can contribute signi cantly to implementing the required management approach in a timely manner and delay additional cognitive decline [43] or developing dementia. Recognizing dementia-speci c factors assists healthcare providers, including nurses, in setting up highly exible and sensitive interventions, treatments, and protocols to meet patients' needs in nursing homes [44][45][46]. Further research should be conducted to address the extent to which we can consider cognitive changes that accompany normal aging and to what extent these changes are related to pathological conditions.…”