Influence of leadership on implementing Dementia Care Mapping: A multiple case study

Abstract

Dementia Care Mapping is an internationally applied method for enhancing person-centred care for people with dementia in nursing homes. Recent studies indicate that leadership is crucial for the successful implementation of Dementia Care Mapping; however, research on this topic is rare. This case study aimed to explore the influence of leadership on Dementia Care Mapping implementation in four nursing homes. Twenty-eight interviews with project coordinators, head nurses and staff nurses were analysed using qualitative content analysis. Nursing homes that failed to implement Dementia Care Mapping were characterised by a lack of leadership. The leaders of successful nursing homes promoted person-centred care and were actively involved in implementation. While overall leadership performance was positive in one of the successful nursing homes, conflicts related to leadership style occurred in the other successful nursing homes. Thus, it is important that leaders promote person-centred care in general and Dementia Care Mapping in particular. Furthermore, different types of leadership can promote successful implementation. Trial registration of the primary study: Current Controlled Trials ISRCTN43916381.

What hinders and facilitates the implementation of nurse-led interventions in dementia care? A scoping review

“…Table 1 displays characteristics of included studies. Most of the studies were from the Netherlands [19,21,29,30,37,42] and the UK [23,25,28,32,33,40] (each n = 6), followed by Australia [24,34,41], Canada [20,22,27], Norway [26,31,36] (each n = 3), Germany [38,39], and Belgium [18,43] (each n = 2). One multinational study took place in Italy and the Netherlands [35].…”

“…Data concerning barriers and facilitators were collected through interviews [10,43] (n = 24), by means of questionnaires [19,23,24,31,38] (n = 6), field notes or process data notes [26,32,37,38] (n = 4), observation [25,39,40] (n = 3), workshops [36] (n = 1), written evaluations by trainers/instructors [37] (n = 1), residents' records [38] (n = 1) and/or by asking openended questions [18] (n = 1). Qualitative data were analysed using thematic or content analysis [18-27, 29, 31-42] (n = 23) or framework analysis [28,32] (n = 2).…”

“…Barriers: The category organisational culture and vision summarizes influencing factors. Distinctive hierarchical structures [18,27,28,36,38,39], inadequate regulations within the organisation [21,35] and a taskfocused, functional culture of care [34,38,39] are examples for hindering factors within this category. Furthermore, authors of several studies report a lack of management and leader support and engagement as a hindering factor [21, 28, 31-33, 36-38, 40].…”

“…High rates of staff turnover and fluctuation [19,22,32,34,37,38,40,42] as well as demands competing with the intervention [19,21,22,25,26,28,33,34,37,39,40] are mentioned as further barriers. Competing demands comprise other innovations or organisational changes taking place at the same time as well as multiple and contradictory requirements.…”

“…Facilitators: Some authors describe a facilitating organisational culture and vision if a person-centred culture was already established [38,39] and the hierarchies were flat [20,24,38,39].…”