Introducing a nursing guideline on depression in dementia: A multiple case study on influencing factors
Section snippets
What is already known about the topic?
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Introducing new guidelines or other care innovations into practice is no guarantee for success. Successful introduction seems to be most difficult in chronic care.
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Obstacles to use guidelines often arise at different levels of the health care system: at the level of the patients, the individual professional, the health-care team, the health-care organization or the wider environment.
What this paper adds
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Factors influencing a successful introduction of the nursing guideline ‘Depression in Dementia’ are mainly found at the first two levels of the nursing home: nursing home management-level and nursing team-level. Factors influencing a successful application of the guideline are mainly found on the last two levels: CNA-level and resident-level.
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Next to the well known factors ‘stability of the organization’, and ‘compatibility of the guideline with current practice and vision’, other important
Intervention
The guideline was based on the principles of the BehaviorTherapy-PleasantEvents method as developed by Teri et al. (1997), which was shown to be effective in reducing depression in people with dementia still living in the community. Key elements of the newly developed guideline are (1) inducing individualized pleasant events, and (2) reducing unpleasant events. The guideline was developed according to the internationally validated AGREE criteria (AGREE Collaboration, 2003).
The strategies to
Success of the guideline introduction
Table 1 provides the scores of the nine nursing home wards on the variable ‘success of the guideline introduction’.The last column in Table 1 shows the division of the nine wards into three groups:
- (1)
successful wards (nos. 1–3);
- (2)
moderately successful wards (nos. 4–7);
- (3)
unsuccessful wards (nos. 8 and 9).
Box 3 describes the guideline introduction on two of the successful wards (nos. 1 and 3) and Box 4 the introduction at the two unsuccessful wards (nos. 8 and 9).
Factors that relate to a successful guideline introduction and application
Factors that play a role in the
Inhibiting and facilitating factors
In this paper factors influencing a successful introduction and actual use of the nursing guideline ‘Depression in Dementia’ were studied. The guideline introduction proved to be successful on three of the nine participating experimental wards, moderately successful on four of these wards and not-successful on two wards. Factors influencing the guideline introduction and application were categorized on four levels: nursing home management (level 1), nursing team (level 2), individual CNAs
Conclusions
By pursuing a multiple case study design it is possible to show which factors facilitate or inhibit a successful introduction and application of the nursing guideline ‘Depression in Dementia’ on psychogeriatric nursing home wards. Factors influencing a successful introduction are mainly found at the first two levels of the nursing home: nursing home management (level 1) and nursing team (level 2). Factors influencing a successful application of the guideline are mainly found on the last two
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