The project aimed to understand how collaboration during the planning of work among care workers at an elderly care home can be supported with a digital tool. This topic is essential, especially considering Sweden's e-Health Vision 2025 to become a global leader in implementing welfare technologies. With rapid technological changes, it is crucial to understand the experiences and perspectives of the individuals using these technologies. The project conducted a literature review, user research, and user testing with care workers in Lund municipality established in design criteria. The design proposals focused on utilizing Welfare Technology to foster collaboration and were evaluated through a prototype created in Figma. Four design proposals were formulated as a result of the project: a large shared viewing screen, enhanced task information and clarity, task ownership, and providing an overview.

Background: People living with advanced dementia in nursing homes often spend the majority of time alone, with little contact with anyone. The need to connect with others is a central part of a philosophy known as Person Centred Dementia Care. A significant body of literature demonstrates the effectiveness of a range of approaches that facilitate connections, yet, we know little about staff perspectives on what facilitates them to connect on a daily basis. Aim: To develop a Grounded Theory to explain what facilitates nursing home staff to connect with residents living with advanced dementia. Methods: Semi structured interviews were conducted with nursing home staff (n=21) and relatives (n=5) from seven nursing homes. Following Strauss and Corbin’s (1990, 1998) Interpretivist Grounded Theory methodology, data collection and analysis proceeded iteratively, and theoretical sampling was used to develop the emergent theory. Results: The Grounded Theory ‘making the most of time’ explains that most connections occurred during personal care. Interdependent contextual and individual factors facilitated staff to make the most of time. Effective leaders were described to create a caring culture in which informal leaders (experienced staff) acted as role models. Staff were then more likely to understand, accept and tolerate dementia, know connections were part of their role, get to know residents and express caring values. In the right physical environment, this then facilitated staff to make the most of time during personal care. Increased training and education from specialised dementia units and experiential knowledge from family engagement then supplement such contexts. Implications: Future research could empirically test the theory ‘making the most of time’

Background: Transitions out of hospital result in poor outcomes for older people. Research investigating transitions for care home residents living with dementia is limited, even though such residents often have multi-morbidities and frequently use hospital services. Nurses are key care providers. Yet their perspectives on optimising care for people living with dementia transferring back to their care home remains under explored. Aims: This qualitative descriptive study explores hospital and care home nurses’ perspectives on how they optimise care for people living with dementia who transfer from hospital back to their care home, and the alignment of this care with best practice. Methods: Thirty-three nurses participated in either semi structured interviews or focus groups. Data were analysed using qualitative content analysis. Results: Nurses described four roles: 1) exchanging information, 2) assessing and meeting needs, 3) working with families and 4) checking and organising medication. They described care home residents with dementia as having distinct needs and variation in how they provided care. Nurses described interdependent roles, but care home nurses were often excluded from involvement in planning resident’s care on return and were not fully recognised as members of wider healthcare teams. Facilitators for optimising care include: nurses understanding the principles of dementia care, nurse leadership and autonomy, having positive relationships between hospital and care home nurses and opportunities for joint working. The care practices nurses described broadly aligned with best practice. Implications: Hospital and care home nurses require joint working opportunities to understand their roles and build relationships. Care home nurses’ status needs to be addressed with action to support their integration into the wider healthcare system. / Alzheimer’s Society (UK)

<p><strong>Background:</strong> Despite strong evidence, strategies for improving bone health are underutilized. Knowledge translation (KT) interventions aim to improve uptake of evidence-based practices, however the feasibility and effectiveness of such strategies require further evaluation within Long-term Care (LTC). In this thesis, we examined the impacts of a province-wide osteoporosis strategy and a more intensive multifaceted KT strategy including expert-led educational meetings, audit/feed-back, and action planning for quality improvement. Both studies targeted interdisciplinary LTC teams (physicians, nurses, pharmacists, dietician, and other staff).</p> <p><strong>Methods: </strong>In the first thesis study, we examined the impact of the <em>Ontario Osteoporosis Strategy for LTC</em> by investigating changes in facility-level prescribing rates (vitamin D, calcium, osteoporosis medications) before and after its implementation (2007 versus 2012). The second study was a pilot cluster randomized trial evaluating the feasibility and effectiveness of a 12-month, multifaceted, interdisciplinary KT intervention [Vitamin D and Osteoporosis Study (ViDOS)]. Prescribing outcomes included: vitamin D ≥800 IU (primary), calcium ≥500 mg/day, and osteoporosis medications (high-risk residents only). Feasibility outcomes included recruitment, retention, data collection, intervention fidelity, and process changes. We analyzed resident level data using the generalized estimating equations (GEE) technique, adjusting for clustering.</p> <p><strong>Results:</strong></p> <p>In both studies, significant improvements were observed for vitamin D and calcium prescribing. In the first study, prescribing increased by 38% and 4%, respectively, between 2007 and 2012. In the ViDOS trial, the 12-month intervention resulted in an absolute improvement of 15% and 7%, respectively (intention to treat cohort). There was no significant effect for prescribing of osteoporosis medications in either study. In the ViDOS study, recruitment and retention rates were 22% and 63%, respectively; good intervention fidelity was achieved and intervention homes reported several process changes.</p> <p><strong>Conclusion:</strong></p> <p>This thesis study demonstrated that KT interventions targeting evidence-based osteoporosis and fracture prevention strategies were feasibly and effectively applied with interdisciplinary LTC teams.</p> / Doctor of Philosophy (PhD)

No / Over the years there have been advances in the quality of care provision for people with dementia. How to measure the impact of care on the person with dementia has challenged researchers as, until recently, no evaluation tool offered a comprehensive overview of the behaviour patterns and well-being of persons with dementia. Dementia Care Mapping (DCM) is a tool used by care practitioners and researchers to capture both the process (behaviours) and outcome (well-being) of care and is therefore of use as a tool to evaluate quality of care. This study aims to assess, through DCM, the experience of dementia care provision in residential and nursing homes in two voluntary organizations in England. The data illustrates similarities in the well-being and behaviour patterns of 76 persons with dementia living in six care settings throughout England. Examples of instances when people with dementia were "put down" and when well-being was enhanced, are outlined. The homes in the study were meeting the physical care but not the broader psychosocial care needs of the observed residents. The action taken by the organizations as a result of the DCM evaluations is summarized.

No / Through qualitative in-depth interviews, we collected the views of persons with Parkinson¿s disease (pwPD) and their close relatives in care homes to establish their collective views of the effectiveness of care. We also reviewed the corresponding care plans. Drawing on these two forms of data collection, we compared similarities and differences between the qualitative interview data and the care plan analysis to elaborate on the experience of residential care for pwPD. Close relatives of care home residents can be a fruitful source of information for care home staff, throughout the care planning process, especially in relation to the specific needs of a pwPD. Although health and social policy advocate active collaboration between people with long-term conditions, their families, and their formal carers, there is limited evidence of such collaboration in the data examined here. There is an apparent shortfall in the knowledge and understanding of PD among care home staff. There are important pragmatic (e.g. drug administration) as well as psycho-social reasons for flexibility in routine care provision to meet the dynamic needs of pwPD. The findings here support the need for further, larger scale research into the quality of care for pwPD who are care home residents.

No / The author explains how Dementia Care Mapping can be used as powerful preventative tool for safeguarding people with dementia from abuse. Used as part of the process of developing person-centred care, the Dementia Care Mapping tool can be used to identify the preconditions of abuse within care settings.

Yes / The majority of people with dementia in the UK die in care homes. The quality of end of life care in these environments is often suboptimal. The aim of the present study was to explore the context, mechanisms and outcomes for providing good palliative care to people with advanced dementia residing in UK care homes from the perspective of health and social care providers. Method: The design of the study was qualitative which involved purposive sampling of health care professionals to undertake interactive interviews within a realist framework. Interviews were completed between September 2012 and October 2013 and were thematically analysed and then conceptualised according to context, mechanisms and outcomes. The settings were private care homes and services provided by the National Health Service including memory clinics, mental health and commissioning services in London, United Kingdom. The participants included 14 health and social care professionals including health care assistants, care home managers, commissioners for older adults’ services and nursing staff. Results: Good palliative care for people with advanced dementia is underpinned by the prioritisation of psychosocial and spiritual care, developing relationships with family carers, addressing physical needs including symptom management and continuous, integrated care provided by a multidisciplinary team. Contextual factors that detract from good end of life care included: an emphasis on financial efficiency over person-centred care; a complex health and social care system, societal and family attitudes towards staff; staff training and experience, governance and bureaucratisation; complexity of dementia; advance care planning and staff characteristics. Mechanisms that influence the quality of end of life care include: level of health care professionals’ confidence, family uncertainty about end of life care, resources for improving end of life care and supporting families, and uncertainty about whether dementia specific palliative care is required. Conclusions: Contextual factors regarding the care home environment may be obdurate and tend to negatively impact on the quality of end of life dementia care. Local level mechanisms may be more amenable to improvement. However, systemic changes to the care home environment are necessary to promote consistent, equitable and sustainable high quality end of life dementia care across the UK care home sector

Yes / People with advanced dementia are frequently bed-bound, doubly incontinent and able to speak only a few words. Many reside in care homes and may often have complex needs requiring efficient and timely response by knowledgeable and compassionate staff. The aim of this study is to improve our understanding of health care professionals’ attitudes and knowledge of the barriers to integrated care for people with advanced dementia. In-depth, interactive interviews conducted with 14 health care professionals including commissioners, care home managers, nurses and health care assistants in the UK. Barriers to care for people with advanced dementia are influenced by governmental and societal factors which contribute to challenging environments in care homes, poor morale amongst care staff and a fragmentation of health and social care at the end of life. Quality of care for people with dementia as they approach death may be improved by developing collaborative networks to foster improved relationships between health and social care services.

No / In the UK, one third of the 850,000 people with dementia live in care homes. This article explores the process of carrying out research in nursing homes, identifying barriers and enabling factors, and making recommendations for researchers. The authors’ experiences derive from an ongoing study investigating the effect of educational interventions to promote and embed person-centred care, designed for nurses caring for the people with dementia in nursing homes. Design issues arose from the need to use cluster randomisation which requires a large sample size, implementation fidelity, poor compliance and high numbers of participants lost to follow up. Further difficulties included gaining ethical approval, recruitment, raising concerns and the practicalities of participant retention. There are many benefits of conducting research in care homes, for the homes themselves, their staff and residents. These include training and education, networking and empowerment of staff and subsequent improved standards of care. For the research team, benefits include opportunities to contribute to an underserved setting, to advance care standards and improve nurses’ working lives. / The authors would like to acknowledge the Burdett Trust for Nursing who funded the study