Abstract
Background: People with dementia often receive care in dementia special care units of nursing homes. The concept of these units vary considerably. Knowledge about the effects and mechanisms of action of dementia special care units is limited. The aim of the study was to evaluate a specific care concept of a dementia special care unit in long-term care. In this paper, we present the results of the evaluation study in the form of a revised program theory. The aim was to describe the components of the care concept, its context as well as its mechanisms of impact and outcomes for persons with dementia and the nursing staff members.
Methods: We conducted a theory-driven evaluation resulting in a revised program theory. The revision was based on an initial program theory and the findings of the outcome/process evaluation. The primarily data-driven revision is enriched by theory and further literature. Data analysis followed a two-step process: evaluation of the original program theory and construction of the revised program theory, consisting of an action and a change model.
Results: The action model describes interventions, context, target groups and implementers. The change model details how the program generates outcomes. Structural, organizational and educational elements promote a shared person-centered understanding of care among nurses. A unified understanding of care favors engagement in meaningful activities and social interactions. It also supports early interventions addressing challenging behavior. Mutually reinforcing interventions create positive experiences and maintain the residents’ personhood. The success of the program is largely based on a workplace culture and a leadership style facilitating person-centered ways of working.
Conclusion: The revised program theory highlights the positive effects of the dementia special care unit care concept on staff and residents. It provides starting points for future practice development. Considering the interdependence of interventions, increased promotion of meaningful activities and social interactions seem advisable. Future research should explore whether the mechanisms of action developed for a specific care concept are transferable to a broader program theory for specialized dementia care.
Trial registration: DRKS00011513