This review has identified key issues in the care of people with dementia in the acute setting: improving pathways of care, creating suitable environments, addressing resources and staffing levels and placing emphasis on the education for staff caring for people with dementia. Recommendations are made for practice consideration, policy development and future research. Leadership is required to instil the values needed to care for this client group in an effective and personcentred way. Qualitative evidence synthesis can inform policy and in this case, recommends VIPS as a suitable framework for guiding decisions around care for people with dementia in acute settings.

There is some support for the value of information services, but studies are needed to determine the specific elements that are effective.

Aims and objectives. To explore the experiences and perceptions of healthcare staff caring for people with dementia in the acute setting. This article focuses on the methodological process of conducting framework synthesis using NVIVO for each stage of the review: screening, data extraction, synthesis and critical appraisal. Background. Qualitative evidence synthesis brings together many research findings in a meaningful way that can be used to guide practice and policy development. For this purpose, synthesis must be conducted in a comprehensive and rigorous way. There has been previous discussion on how using NVIVO can assist in enhancing and illustrate the rigorous processes involved. Design. Qualitative framework synthesis. Methods. Twelve documents, or research reports, based on nine studies, were included for synthesis. Conclusion. The benefits of using NVIVO are outlined in terms of facilitating teams of researchers to systematically and rigorously synthesise findings. NVIVO functions were used to conduct a sensitivity analysis. Some valuable lessons were learned, and these are presented to assist and guide researchers who wish to use similar methods in future. Relevance to clinical practice. Ultimately, good qualitative evidence synthesis will provide practitioners and policymakers with significant information that will guide decision-making on many aspects of clinical practice. The example provided explored how people with dementia are cared for acute settings.Key words: dementia, framework synthesis, NVIVO, qualitative evidence synthesis, sensitivity analysisWhat does this paper contribute to the wider global clinical community?• Qualitative evidence synthesis is valuable for policy development and to guide practitioners in clinical settings.• The query tools within NVIVO can facilitate sensitivity analysis to check the impact of the findings from reports deemed of a lesser quality.• It can be concluded that NVIVO is suitable for framework synthesis and works well for teams working on qualitative evidence synthesis. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Organisational culture of institutions providing care for older people is increasingly recognised as influential in the quality of care provided. There is little research, however, that specifically examines the processes of care home culture and how these may be associated with quality of care. In this paper we draw from an empirical study carried out in the United Kingdom (UK) investigating the relationship between care home culture and residents' experience of care. Eleven UK care homes were included in an in-depth comparative case study design using extensive observation and interviews. Our analysis indicates how organisational cultures of care homes impact on the quality of care residents receive. Seven inter-related cultural elements were of key importance to quality of care. Applying Schein's conceptualisation of organisational culture, we examine the dynamic relationship between these elements to show how organisational culture is locally produced and shifting. A particular organisational culture in a care home cannot be achieved simply by importing a set of organisational values or the 'right' leader or staff. Rather, it is necessary to find ways of resolving the everyday demands of practice in ways that are consistent with espoused values. It is through this everyday practice that assumptions continuously evolve, either consistent with or divergent from, espoused values. Implications for policy makers, providers and practitioners are discussed.KEY WORDS -residential care, nursing homes, culture, quality of care, dementia.

Objectives: This paper reports on the acceptability and effectiveness of the FITS (Focussed Intervention Training and Support) into Practice Programme. This intervention was scaled up from an earlier cluster randomised-controlled trial that had proven successful in significantly decreasing antipsychotic prescribing in care homes. Method: An in depth 10-day education course in person-centred care was delivered over a three-month period, followed by six supervision sessions. Participants were care-home staff designated as Dementia Care Coaches (DCCs) responsible for implementing interventions in 1 or 2 care homes. The course and supervision was provided by educators called Dementia Practice Development Coaches (DPDCs).Effectiveness data included monitoring antipsychotic prescriptions, goal attainment, knowledge, attitudes and implementation questionnaires. Qualitative data included case studies and reflective journals to elucidate issues of implementation. Results: Of the 100 DCCs recruited, 66 DCCs completed the programme. Pre-post questionnaires demonstrated increased knowledge and confidence and improved attitudes to dementia. Twenty per cent of residents were prescribed antipsychotics at baseline which reduced to 14% (31% reduction) with additional dose reductions being reported alongside improved personalised goal attainment. Crucial for FITS into Practice to succeed was the allocation and protection of time for the DCC to attend training and supervision and to carry out implementation tasks in addition to their existing job role. Evaluation data showed that this was a substantial barrier to implementation in a small number of homes. Discussion and conclusions: The FITS into practice programme was well evaluated and resulted in reduction in inappropriate anti-psychotic prescribing. Revisions to the intervention are suggested to maximise successful implementation.

Women are disproportionately affected by dementia, both in terms of developing dementia and becoming caregivers. We conducted an integrative review of English language literature of the issues affecting women in relation to dementia from an international perspective. The majority of relevant studies were conducted in high income countries, and none were from low-income countries. The effects of caregiving on health, wellbeing and finances are greater for women; issues facing women, particularly in low and middle-income countries need to be better understood.Research should focus on building resilience to help people adjust and cope long term.Dementia is a global public health issue that disproportionately affects women, either through developing the condition themselves, or as a carer for someone with dementia. The effects on women of living with or caring for someone with dementia from an international perspective needs to be more fully understood. In our review of the published literature, we explore the impact of dementia on changing roles, identity, wellbeing and finances for women in both high-income and low-and middle income countries. An improved understanding of these factors can support research, and policy developments, that address the issues specifically relevant to women.As age is the greatest risk factor for dementia, and women have a greater life expectancy worldwide than men, a larger number of people with dementia are women (Alzheimer's Association, 2014).There are also clinical differences between genders in disease risk and severity, especially in relation to dementia and cognition (Carter et al., 2012). There is a significant association between age, gender, and dementia in many areas of the world, with women showing a higher prevalence rate for dementia than men (Bamford, 2011;Takeda et al., 2011; Alzheimer's Disease International, 2015) expectation that women will assume caregiving roles (Godfrey & Warshaw, 2009;Lantz, 2009;Gibbons et al., 2014). In many studies of dementia caregivers, all or most participants are women, reflecting the disproportionate extent to which women are relied upon as carers, although few reports focus on gender specifically (Robinson et al., 2014). Therefore the assumption that women provide informal care to people with dementia is embedded (often implicitly) in much of the existing research.The financial impact of providing dementia care on family caregivers is substantial; caregivers in the United States reported that they were reluctant to take time off work to provide care, or took on additional work to cover caregiving costs, which had increased because of the recent economic downturn (Evercare, 2009). Women may also have the responsibility of caring for young children alongside caring for a parent with dementia -referred to as the 'sandwich generation' (Solberg et 3 al., 2014). Despite this (often dual) caring responsibility, families often prefer , for a variety of cultural, obligational and practical reasons to continue to provide care at ho...

MCSPs showed significant wellbeing and health benefits compared with UC, building on the evidence of effectiveness from the Netherlands. In addition to the previously reported successful implementation of MCSP in Italy, Poland, and the UK, these findings suggest that further international dissemination of MCSP is recommended.

This article reports on the outcome and evaluation of the focused intervention training and support (FITS) into practice programme, a training and support programme for care home staff aimed at reducing inappropriate anti-psychotic prescribing for people living with dementia by implementing alternative psychosocial interventions. This programme was adapted from an original randomised-controlled trial that successfully reduced the prescribing of anti-psychotic medications in care homes. The aim of the new programme was to replicate the impact of the original trial, but using a less resource-intense model, so that it could be implemented across care homes in the UK within existing resource conditions. The programme successfully reduced anti-psychotic prescribing and improved staff knowledge and attitudes. Barriers and facilitators of implementation were identified at four key levels: the dementia care coach; the care home; the organisation; and external relationships. Crucial to success was the provision of dedicated time for dementia care coaches to implement, the ongoing support provided by the expert-practitioner role, and the quality of relationships with prescribers. The implications of these for the FITS into practice programme, other similar interventions, and the work of prescribers with care homes are discussed.