A theory of change of an innovation for therapeutic care and meaningful living in a German nursing home.
De-institutionalization
Integrated narrative nursing
Meaning-making
Nursing home culture change
Positive gerontology
Therapeutic emplotment
Journal
BMC geriatrics
ISSN: 1471-2318
Titre abrégé: BMC Geriatr
Pays: England
ID NLM: 100968548
Informations de publication
Date de publication:
11 11 2022
11 11 2022
Historique:
received:
11
04
2022
accepted:
07
09
2022
entrez:
11
11
2022
pubmed:
12
11
2022
medline:
16
11
2022
Statut:
epublish
Résumé
Demographic changes are leading to growing care needs of older people and creating a challenge for healthcare systems worldwide. Nursing homes (NHs) need to provide care for growing numbers of residents while ensuring a high-quality care. We aimed to examine an innovative NH in Germany and apply a theory of change (ToC) approach to develop a best practice model (BPM) for therapeutic care in NHs. A multimethod qualitative study conducted from February to July 2021 in Germany involved interviews with 14 staff members of an innovative NH and 10 directors and care managers of other NHs. The interview guidelines included questions on nursing practices, infrastructure, resources, interprofessional collaboration, and working culture. Additional material on the participating NH (website, promotion videos, newsletters, care documentation) were collected. Contextual literature on NH culture and therapeutic care in Germany, ToC methodology, and NH culture change were reviewed. Following a question-focused analysis of all material, we generated a ToC model towards a BPM of therapeutic care and meaningful living in NHs. Results were verified in interdisciplinary team meetings, with study participants and other stakeholders to establish consensus. The participating NH's care concept aims to improve residents' functional abilities and wellbeing as well as staff members' job satisfaction. Central components of their approach include therapeutic elements such as music and movement in all nursing activities, multidisciplinary collaboration, a broad therapy and social activity offer, the continuation of therapy in everyday activities, a focus on individual life history, values, needs, and skills, social integration into the regional community, and the creation of a meaningful living environment for residents and staff. The BPM we developed shows how a meaningful living environment can be created through therapeutic care and integrative activities. The ToC sheds light onto the contextual factors and cultural values which should be considered in the development of NH interventions. Research on not only biomedical aspects, but also psychosocial dynamics and narrative co-constructions in nursing practice should inform NH innovations. The ToC also highlights the importance of developing adequate political frameworks and infrastructures for implementing such innovative practices on a larger scale.
Sections du résumé
BACKGROUND
Demographic changes are leading to growing care needs of older people and creating a challenge for healthcare systems worldwide. Nursing homes (NHs) need to provide care for growing numbers of residents while ensuring a high-quality care. We aimed to examine an innovative NH in Germany and apply a theory of change (ToC) approach to develop a best practice model (BPM) for therapeutic care in NHs.
METHODS
A multimethod qualitative study conducted from February to July 2021 in Germany involved interviews with 14 staff members of an innovative NH and 10 directors and care managers of other NHs. The interview guidelines included questions on nursing practices, infrastructure, resources, interprofessional collaboration, and working culture. Additional material on the participating NH (website, promotion videos, newsletters, care documentation) were collected. Contextual literature on NH culture and therapeutic care in Germany, ToC methodology, and NH culture change were reviewed. Following a question-focused analysis of all material, we generated a ToC model towards a BPM of therapeutic care and meaningful living in NHs. Results were verified in interdisciplinary team meetings, with study participants and other stakeholders to establish consensus.
RESULTS
The participating NH's care concept aims to improve residents' functional abilities and wellbeing as well as staff members' job satisfaction. Central components of their approach include therapeutic elements such as music and movement in all nursing activities, multidisciplinary collaboration, a broad therapy and social activity offer, the continuation of therapy in everyday activities, a focus on individual life history, values, needs, and skills, social integration into the regional community, and the creation of a meaningful living environment for residents and staff.
CONCLUSION
The BPM we developed shows how a meaningful living environment can be created through therapeutic care and integrative activities. The ToC sheds light onto the contextual factors and cultural values which should be considered in the development of NH interventions. Research on not only biomedical aspects, but also psychosocial dynamics and narrative co-constructions in nursing practice should inform NH innovations. The ToC also highlights the importance of developing adequate political frameworks and infrastructures for implementing such innovative practices on a larger scale.
Identifiants
pubmed: 36368919
doi: 10.1186/s12877-022-03462-0
pii: 10.1186/s12877-022-03462-0
pmc: PMC9651899
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
849Informations de copyright
© 2022. The Author(s).
Références
Rehabilitation (Stuttg). 2018 Apr;57(2):100-107
pubmed: 28558399
Int Psychogeriatr. 2010 Nov;22(7):1025-39
pubmed: 20522279
Gerontologist. 2008 Apr;48(2):142-8
pubmed: 18483426
Z Gerontol Geriatr. 2021 Nov;54(Suppl 2):108-113
pubmed: 34160675
BMC Health Serv Res. 2020 Aug 26;20(1):801
pubmed: 32847580
J Affect Disord. 2012 Dec 15;142(1-3):290-6
pubmed: 22901400
Rehabilitation (Stuttg). 2014 Aug;53(4):237-44
pubmed: 24390873
Soc Sci Med. 1994 Mar;38(6):811-22
pubmed: 8184332
Psychol Health. 2015;30(5):568-82
pubmed: 25420618
Implement Sci. 2016 May 06;11:63
pubmed: 27153985
BMC Geriatr. 2021 Dec 7;21(1):680
pubmed: 34876048
Lancet. 2014 Mar 15;383(9921):927
pubmed: 24629279
Eur J Public Health. 2019 Feb 1;29(1):58-67
pubmed: 29878101
Psychol Monogr. 1966;80(1):1-28
pubmed: 5340840
Health Promot Int. 2015 Sep;30(3):769-81
pubmed: 24682545
Gerontologist. 2014 Feb;54 Suppl 1:S1-5
pubmed: 24443601
Health Serv Res. 2002 Aug;37(4):849-84
pubmed: 12236388
Front Med (Lausanne). 2020 May 19;7:160
pubmed: 32509790
J Am Med Dir Assoc. 2020 May;21(5):604-614.e6
pubmed: 32280002
Soc Sci Med. 2021 May;277:113904
pubmed: 33839468
BMC Geriatr. 2017 Jul 19;17(1):155
pubmed: 28724358
Cochrane Database Syst Rev. 2009 Jul 08;(3):CD000072
pubmed: 19588316
Nurs Res Pract. 2013;2013:932381
pubmed: 23691302
Aging Ment Health. 2015;19(11):1031-41
pubmed: 25584744
Jpn J Nurs Sci. 2020 Jul;17(3):e12330
pubmed: 32067384
Rehabilitation (Stuttg). 2015 Aug;54(4):273-8
pubmed: 26317843
Z Gerontol Geriatr. 2016 Oct;49(7):612-618
pubmed: 26458912
J Aging Stud. 2015 Dec;35:95-103
pubmed: 26568219
Acta Biomed. 2016 Nov 22;87(4-S):13-22
pubmed: 27874840
Nurs Open. 2019 Jul 03;6(3):1230-1236
pubmed: 31367449
Gerontologist. 2014 Aug;54(4):634-50
pubmed: 24009169
Curr Pharm Des. 2014;20(19):3114-8
pubmed: 24050170
J Adv Nurs. 2001 Nov;36(3):426-32
pubmed: 11686757
Trials. 2014 Jul 05;15:267
pubmed: 24996765
Int J Older People Nurs. 2012 Sep;7(3):188-99
pubmed: 21631889
Gerontologist. 2014 Feb;54 Suppl 1:S35-45
pubmed: 24443604
Gerontologist. 2020 Nov 23;60(8):1411-1423
pubmed: 32478393
Nurs Ethics. 2021 Mar;28(2):149-178
pubmed: 33000674
Qual Health Res. 2021 Sep;31(11):2029-2040
pubmed: 34286610
Nurs Forum. 1968;7(3):275-88
pubmed: 5188207
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2016 Jan;59(1):105-12
pubmed: 26511126
J Adv Nurs. 2017 Aug;73(8):1884-1895
pubmed: 28229474
Gerontologist. 2014 Feb;54(1):93-100
pubmed: 24009172