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Background: To ensure high-quality care for residents living with dementia, recommendations for dementia-specific care do exist internationally as well as in Germany. Nevertheless, it remains unclear how dementia-specific care is currently provided and what can be derived from this for the improvement of dementia-specific care. Therefore, this study aimed to investigate the provision of dementia-specific care and related problems in German nursing homes. Methods: We used a holistic multiple case design with a total of four cases. The cases were defined as care units in which residents living with dementia were cared for. For data collection, we used problem-centered face-to-face interviews, document analysis, and context questionnaires and analyzed all qualitative data inductively and deductively using content structuring qualitative analysis. To identify case-specific and cross-case patterns and themes, we focused on similarities and differences between the cases. The reporting followed the EQUATOR reporting guideline for organizational case studies. Results: We interviewed 21 professionals, 14 relatives and 8 residents living with dementia. Despite context-specific differences, we identified a variation of care practices and problems in applying person-centered, dementia-specific care in German nursing homes. In all cases, these belong to the following topics: 1) handling neuropsychiatric symptoms, 2) dealing with communication difficulties, 3) providing person-centered interaction and communication, 4) dealing with stress caused by experiencing dementia-specific symptoms and 5) using and sharing knowledge. Even though the problems were identified in all cases, we also found differences in the extent and perception of these problems across the analyzed cases. Discussion: Despite existing conceptual recommendations and described care practices in our study, the identified problems showed that current care practices are perceived as problematic and partly are not person-centered. This highlights that person-centered requirements in dementia-specific care are not yet adequately addressed and that there is a need to give greater consideration to the identified problems when developing interventions to improve quality of care. Furthermore, the identified context-specific differences in the extent and perception of these problems show that the designs of new care models should allow for more flexibility, so that written recommendations can be implemented in practice and adapted to given contexts. [ABSTRACT FROM AUTHOR]

Aims and objective: To identify and summarise core elements, resident‐, staff‐ and process‐related outcomes and challenges of nurse‐led care models in residential long‐term care. Background: Due to demographic trends, the complexity of residential long‐term care has increased. To address this complexity, the implementation of nurse‐led care models has been recommended. Design: Scoping review. Methods: A systematic search was conducted of English and German articles in CINAHL via EBSCO, MEDLINE via PubMed, Cochrane Library and Scopus. Forward and backward citation tracking via reference lists and Google Scholar supplemented the search. The final update was made on 19 January 2021. To draw conclusions about the potential of nurse‐led care models, evaluation studies of the described models for residents in nursing homes were included. Full texts were independently screened and assessed for methodological quality. Data were extracted and summarised in tables and synthesised for analysis. The core elements of the models were described using the Sustainable intEgrated chronic care modeLs for multimorbidity: delivery, FInancing and performancE (SELFIE) framework. The review followed the PRISMA‐ScR guideline. Results: We included 13 studies of 12 nurse‐led care models. The different models comprised many of the core elements suggested in the SELFIE framework, particularly in the components service delivery, workforce, and leadership and governance. The studies reported a broad range of resident‐, staff‐ and process‐related outcomes and challenges considered relevant to the success of the models. Conclusions: Studies evaluating nurse‐led care models in nursing homes are limited and of moderate quality. This review demonstrates that nurse‐led care models include many elements for care coordination and could improve resident‐, staff‐ and process‐related outcomes. Relevance to clinical practice: This review highlights that nurse‐led care models share common core elements despite their heterogeneity. It also shows that highly qualified nurses in nurse‐led care models can advance nursing practice in nursing homes. [ABSTRACT FROM AUTHOR]

Background: The built environment is a key component of dementia-specific care. Little is known about the characteristics of dementia-sensitive environmental elements in living units of nursing homes in Germany. The German Environmental Audit Tool (G-EAT) is a systematic assessment tool for describing these elements in detail., Aim of the Study: To describe the extent of dementia-sensitive design principles and environmental elements in a regionally limited sample of living units in Germany., Methods: The built environment was assessed using G-EAT and analysed quantitatively and descriptively. Definitions of living units were developed based on site visits and analysed using qualitative content analysis., Results: The 42 participating living units were heterogeneous in terms of space and composition. Dementia-sensitive design principles varied greatly in their implementation in the built environment; on average, 87.7% of the environmental elements were oriented towards a familiar environment. In contrast, visual accessibility was much less frequently enabled by the built environment (mean 37.3%)., Conclusions: The characteristics of various dementia-sensitive environmental elements need to be further investigated against the background of the nursing home care concept and the homogeneity of the resident group to enable the initiation of tailored environmental adaptation that can be implemented by interdisciplinary teams in nursing homes. This also requires a follow-up study with a larger sample of living units to identify the factors that promote and inhibit the development of a dementia-sensitive environment., Competing Interests: The authors declare that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)