Background: Several efforts have been made to change management of neuropsychiatric symptoms (NPS) in nursing homes, however only few were successful. Numerous barriers to change in healthcare were identified, yet only one conceptual model is known to study their interrelationships. Unfortunately, this model does not discuss specific barriers encountered in nursing home practice. The aim of this study is to explore perceived barriers to change in the management of NPS in nursing homes and to construct a conceptual framework providing insight into the relative importance and interrelationships of these barriers when improving quality of care.
Methods: Four focus groups were conducted in different dementia special care units of one Dutch nursing home. Participants were either nursing staff, treatment staff or relatives of residents. Qualitative thematic analysis was conducted according to the five phases defined by Braun & Clarke. Finally, a conceptual framework showing the interrelations of barrier-themes was constructed using text fragments of the focus groups.
Results: We constructed a conceptual framework consisting of eight themes of barriers explaining the extent to which change in NPS-management can be achieved: 'organizational barriers', 'personal barriers', 'deficiency of staff knowledge', 'suboptimal communication', 'inadequate (multidisciplinary) collaboration', 'disorganization of processes', 'reactive coping' and 'differences in perception'. Addressing 'organizational barriers' and 'deficiency of staff knowledge' is a precondition for change. 'Suboptimal communication' and 'inadequate (multidisciplinary) collaboration' play a key role in the extent of change achieved via the themes 'differences in perception' and 'disorganization of processes'. Furthermore, 'personal barriers' influence all themes - except 'organizational barriers' - and may cause 'reactive coping', which in turn may lead to 'difficulties to structure processes'.
Conclusions: A conceptual framework was created explaining the relationships between barriers towards achieving change focused on improving management of NPS in nursing homes. After this framework has been confirmed and refined in additional research, it can be used to study the interrelatedness of barriers to change, and to determine the importance of addressing them for achieving change in the provided care.
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http://dx.doi.org/10.1186/s12877-020-01569-w | DOI Listing |
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The PRO-CARE Group, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden.
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J Clin Transl Sci
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University of Colorado Clinical and Translational Sciences Institute - Community Engagement and Health Equity Core, Aurora, CO, USA.
The Colorado Immersion Training in Community Engagement (CIT) program supports a change in the research trajectory of junior faculty, early career researchers, and doctoral students toward Community-Based Participatory Research (CBPR). CIT is within the Community Engagement and Health Equity Core (CEHE) at the Colorado Clinical and Translational Sciences Institute (CCTSI), an NIH-funded Clinical and Translational Science award. This Translational Science Case Study reports on CIT's impacts from 2010 to 2019.
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January 2025
College of Education, The University of Cambodia, Phnom Penh, Phnom Penh, Cambodia.
Traditional educational frameworks in Saudi Arabia have historically adopted a deficit-based approach to special education, potentially overlooking the benefits of neurodiversity. As global educational paradigms shift toward inclusive practices, examining the alignment of Saudi special education laws with neurodiversity principles becomes crucial. This content analysis study aimed to explore the existing literature on special education in Saudi Arabia to ascertain whether the laws and policies support or hinder the practice of neurodiversity, a concept that is gaining international recognition but remains nascent in Saudi Arabia.
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