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(Geriatr Nurs 2009;30:174-187) Aggressive behavior of residents continues to challenge and burden caregivers working in nursing homes [1,2]. Working in a nursing home or long-term care facility is associated with a high risk of experiencing aggression [3].Studies show that aggressive behavior is more likely to occur among older people with cognitive impairment than among those with no cognitive impairment [2,4,5] although cognitively intact residents also threaten or assault the caregivers [6]. Irrespective of whether demented residents can be held responsible for their aggressive behavior, many gerontological nurses find that physical or verbal attacks by an elderly person they are giving nursing care to is one of the most difficult, emotionally distressing, and potentially dangerous aspects of their work [7], often resulting in feelings of powerlessness, sadness, anger, and ineffectiveness [8].Some studies have investigated the prevalence of aggression and associated factors in nursing homes, but it is probable that nursing home residents' aggressive behavior often goes underreported in both prevalence measures and nursing documentation. Possible causes for underreporting are a lack of competence to cope with aggressive behavior, feelings of failure, or the assumption that aggressive behavior is a common feature in the care of the elderly, especially those with psychological disturbance [1,4,9,10]. Psychological disturbances and other illnesses in the elderly may lead to aggressive behavior irrespective of situational factors. However, because such illness processes can be influenced only indirectly by nursing

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.

Patient aggression is a problem in many health care settings, and nursing students are among the most vulnerable to experiencing such aggression. Training courses have been suggested to help nurses better manage patient aggression. Such courses can lead to changes in attitudes toward and perceptions of, as well as greater confidence in managing, aggression. In this quasi-experimental study, we investigated the effect of a training course on nursing students' attitudes toward, perceptions of, and confidence in managing patient aggression. Students in the intervention group demonstrated enhanced confidence but no change in attitude after the training course, while students in the control group remained stable on all measures. The short time frame of the study, the training course itself, and the instruments used for monitoring attitudes toward aggression are possible reasons for these results. We tentatively conclude that it is possible to enhance nursing students' perceived confidence in managing patient aggression without changing their fundamental views of it.