Given the increasing body of empirical evidence, greater recognition is warranted for creating physical environments appropriate and responsive to residents' cognitive abilities and functioning. Future research needs to place greater emphasis on environmental intervention-based studies, diverse sample populations, inclusion of residents in different stages and with multiple types of dementia, and on longitudinal study design.

RÉSUMÉAu cours des trois dernières décennies, il y a eu une augmentation notable dans les études de pratique concernant changements dans les interventions en soins de longue durée (SLD). Cette critique, basé sur une approche réaliste modifi ée, répond aux questions suivantes: Quelles caractéristiques de changement d'intervention fonctionnent bien? Et, dans quelles circonstances, fonctionnent-elles, et pourquoi? Une approche réaliste modifi ée a été appliquée pour identifi er et expliquer les interactions parmi le contexte, le mécanisme, et les résultats. Nous avons cherché des bases de données électroniques et la littérature publiée pour les études empiriques des interventions pratiques modifi ées qui (a) ont été menées dans les établissements de SLD, (b) ont impliqué le personnel soignant formel, et (c) ont fait état d'une évaluation formelle. Quatre-vingt-quatre articles répondaient à nos critères d'inclusion. Les interventions qui ne comprenaient que des facteurs prédisposants étaient moins susceptibles d'être effi caces, tandis que les interventions qui comprenaient des facteurs renforçants étaient les plus susceptibles de produire des résultats durables. Nous avons conclu que les interventions visant à changer les pratiques dans les milieux de SLD devraient inclure les facteurs habilitants et renforçants qui sont à la fois réalisables et effi caces. ABSTRACTOver the past three decades, there has been a notable increase in studies of practice change interventions in longterm care (LTC) settings. This review, based on a modifi ed realist approach, addresses the following questions: What practice change intervention characteristics work? And, in what circumstances do they work and why? A modifi ed realist approach was applied to identify and explain the interactions among context, mechanism, and outcome. We searched electronic databases and published literature for empirical studies of practice change interventions that (a) were conducted in LTC settings, (b) involved formal care staff members, and (c) reported a formal evaluation. Ninety-four articles met the inclusion criteria. Interventions that included only predisposing factors were least likely to be effective. Interventions that included reinforcing factors were most likely to produce sustained outcomes. We concluded that interventions aimed at practice change in LTC settings should include feasible and effective enabling and reinforcing factors.

This study sought to understand the ways in which family caregivers to institutionalized relatives with dementia perceived and experienced the relocation of their relative to a more home-like setting of care. Twenty-nine family members were interviewed through focus groups and individual interviews following the closing of two traditional care facilities and the subsequent migration of all residents to dementia cottages. Questions focused on the assessment and evaluation of quality of care. Results of this qualitative study pointed to the centrality of relationships in creating a truly homelike environment, in addition to what constitutes effective relational practice from the family perspective. We argue that the creation of a meaningful home for persons with dementia must encompass a relational orientation, both philosophically and in practice, that is inclusive of resident, staff, and family.

These findings suggest that both contextual- and individual-level factors exert considerably less influence on I-Care than factors associated to staffs' perceptions of empowerment. Consequently, interventions aimed at increasing I-Care in LTC settings should carefully consider staffs' access to structural empowerment.

This paper offers a critique of Dementia Care Mapping (DCM) as a practice development and research tool by examining the psychometric properties and efficacy of DCM as a method for evaluating and enhancing care quality and quality of life. Based on a review and analysis of the published empirical studies utilizing DCM, it becomes apparent that there is mixed support for the tool's validity and reliability. More importantly, there is a need for additional studies specifically examining the range of related assessments to provide conclusive evidence for DCM's relevance, applicability and reliability as a practice and research tool in dementia care. The paper identifies methodological issues of implementation and use of DCM, i.e., coding practices, mapping duration. Also, a summary of the tool's strengths and limitations in practice and research settings, areas for improvement and future research avenues is provided.