Employing dementia care mapping to implement person-centred care in residential aged care settings : impact on nurses and care staff

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Dementia Care Mapping (DCM) is an outcome measure and process for improving care quality for residents with dementia. It employs a systematic observation and feedback process to foster person-centered care (PCC). PCC is a model that differs philosophically from the medical approach to caring. It focuses on meeting the person's holistic needs by supporting their personhood rather than imposing the rituals and routines of the care organisation on the person. The literature supporting the effectiveness of Dementia Care Mapping (DCM) in assisting nurses and care staff to apply person-centred care (PCC) shows promise, although reports of PCC's acceptability with and uptake by care staff and nurses is limited. Based on a mixed method design, the study examined the impact of introducing PCC through DCM on the practices and attitudes of nurses and care staff, their perception of dementia care work and perceptions of their own well-being as nurses and care workers. Data were derived from small focus groups; nurse's surveys; pre and post test non-participant staff/resident observations and individual semi-structured interviews with nurses and care staff from three high level dementia-specific residential care units in New South Wales. Focus group findings prior to the PCC and DCM interventions identified participant stress and lack of knowledge about PCC. Post-intervention staff questionnaire results showed little or no improvement in staff well-being, job satisfaction or attitudes towards caring for residents with dementia. However, non-participant staff/resident observations revealed increased incidences of positive staff-resident interactions in all units post-intervention, although there was no significant time effect in these observations. Staff member's commitment to caring for residents with dementia was confirmed by the follow-up interview findings. The staff interviews revealed that most participants gained an increased awareness of the resident's individual care needs through the PCC and DCM interventions, which helped them to develop understanding and new insights into resident behaviours, as well as new ways of reducing the cause of resident stress. However, not all staff participants reported a change in PCC practices despite this knowledge gain. The main finding was that the introduction of PCC requires strong leadership and teamwork, supported by a culture that demonstrates an openness to change. The participants who successfully implemented PCC activities with their managers' support reported a sense of connection with the residents and satisfaction with their care work. The interview findings also revealed the negative impact that DCM could have on participants' perceived well-being and their sense of achievement in care delivery. This may have impacted on their perception of PCC and subsequently their change in care practices. Understanding the impact of introducing PCC through the DCM process is important for the residential aged care sector, as it adds to the body of knowledge about PCC in clinical practice and contributes information about how best to implement quality dementia care in ways that are meaningful and useful for staff. It also provides insight into the strategic planning of novel care systems.
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