Dissertations / Theses on the topic 'Dementia Care Mapping (DCM)'

This thesis considers the provision of person-centred care (PCC) in acute healthcare. In recent years it has been increasingly recognised that healthcare should be delivered in a person-centred manner and that staff should receive training and support in relation to this. There is a growing body of literature investigating the potential benefits of PCC in relation to both patient and service level outcomes. Paper one of this thesis is a systematic review of the literature examining staff training interventions for improving PCC in acute healthcare settings. The findings offer preliminary support for the positive impact of such training interventions on patient and service level outcomes in hospital environments. The research in this area is not of a uniformly high standard and this paper concludes that further research in this area is required. Paper two is an examination of a modified version of Dementia Care Mapping (Care Mapping – Neurorehabilitation: DCM-NR), an observational tool for measuring and improving PCC. Results provide evidence of the feasibility and validity of DCM-NR in a range of Clinical Neuroscience settings. Future research should examine the impact of DCM-NR on person-centred practices over time.The critical reflection paper considers both the systematic review and the empirical study. It aims to consider both the strengths and limitations of the research, challenges encountered, clinical implications and highlights areas for future research.

Background. Paper I: Published guidelines and policies continually promote the importance of increasing service-user involvement in health care services. Q-methodology has become a popular method for revealing the subjective perspectives of patients who use health services, yet there is currently no review considering the potential issues of using Q-methodology with clinical populations. Paper II: Measuring the quality of care for people using neurorehabilitation services is a complex area requiring reliable methods. Dementia Care Mapping (DCM) is used widely in dementia care settings to help improve person-centred care and with appropriate evaluation may be usefully applied to neurorehabilitation settings. Aims. Paper I [literature review] examined studies which used Q-methodology with clinical populations, with a particular emphasis on the potential adaptations required to ensure its reliable use. Paper II [research study] explored the acceptability views of staff and patients for the pilot use of DCM in a neurorehabilitation setting. Paper III attempted to critically appraise these papers, as well as the research process overall. Methods. Paper I reviewed 29 studies, published over a 20-year period, using a narrative synthesis. Paper II conducted DCM on an acute neurorehabilitation ward, and evaluated the acceptability of DCM using Q-methodology with 23 staff and 10 patients on the ward. Results. Paper I identified a number of considerations for the effective application of Q-methodology with clinical populations. Paper II, reporting on the factor analysis, indicated a 'consensus' viewpoint, where all participants indicated positive acceptability for the use of DCM in a neurorehabilitation setting, with additional factors indicating some potential changes to the tool for increasing acceptability in the future. Paper II also indicated the potential for Q-methodology to be useful with a neurorehabilitation in-patient population. Conclusion. Paper I indicated the potential worth of Q-methodology for use with clinical populations. It also indicated guidelines which researchers might consider when using this method with clinical populations in the future. Paper II revealed promising results for the acceptability of DCM in a neurorehabilitation setting, though further research is required to explore this further. It also confirmed the value of Q-methodology with patients within a neurorehabilitation setting, similarly to those in Paper I. Paper III explored the relevance of Papers I and II in adding to the literature independently, but also the unequivocal link regarding the use of Q-methodology with clinical populations.

No<br>Objectives This paper describes DCM 8 and reports on the initial validation study of DCM 8. Methods Between 2001-2003, a series of international expert working groups were established to examine various aspects of DCM with the intention of revising and refining it. During 2004-2005 the revised tool (DCM 8) was piloted in seven service settings in the UK and validated against DCM 7th edition. Results At a group score level, WIB scores and spread of Behavioural Category Codes were very similar, suggesting that group scores are comparable between DCM 7 and 8. Interviews with mappers and focus groups with staff teams suggested that DCM 8 was preferable to DCM 7th edition because of the clarification and simplification of codes; the addition of new codes relevant to person-centred care; and the replacement of Positive Events with a more structured recording of Personal Enhancers. Conclusions DCM 8 appears comparable with DCM 7th edition in terms of data produced and is well received by mappers and dementia care staff.

No<br>The published literature on dementia care mapping (DCM) in improving quality of life and quality of care through practice development and research dates back to 1993. The purpose of this review of the research literature is to answer some key questions about the nature of the tool and its efficacy, to inform the ongoing revision of the tool, and to set an agenda for future research. Design and Methods: The DCM bibliographic database at the University of Bradford in the United Kingdom contains all publications known on DCM (http://www.bradford.ac.uk/acad/health/dcm). This formed the basis of the review. Texts that specifically examined the efficacy of DCM or in which DCM was used as a main measure in the evaluation or research were reviewed. Results: Thirty-four papers were categorized into five main types: (a) cross-sectional surveys, (b) evaluations of interventions, (c) practice development evaluations, (d) multimethod evaluations, and (e) papers investigating the psychometric properties of DCM.

Person-centred care (PCC) is recommended when working with patients with neurological difficulties. Despite this, to date there has been no appropriate methodology for assessing or developing PCC in neurorehabilitation settings. Dementia Care Mapping (DCM) is a well-established tool for assessing and developing PCC in dementia settings and the current study investigated the feasibility of applying DCM on an acute neurorehabilitation ward. DCM procedure and coding required minor adaptations for use in this setting and further recommended adaptations were subsequently identified. It was found that the DCM coding system was generally suitable and could identify strengths, weaknesses and areas for development in ward care. Q-methodology identified that staff views endorsed the feasibility of using DCM in neurorehabilitation, with staff reporting that they found DCM useful and relevant to their work. DCM could be further developed for this setting by amendments to the behaviour coding system, concept and coding of person-centred care, and a population-specific manual. DCM is a promising methodology to develop and promote PCC in neurorehabilitation.

No<br>Over the years there have been advances in the quality of care provision for people with dementia. How to measure the impact of care on the person with dementia has challenged researchers as, until recently, no evaluation tool offered a comprehensive overview of the behaviour patterns and well-being of persons with dementia. Dementia Care Mapping (DCM) is a tool used by care practitioners and researchers to capture both the process (behaviours) and outcome (well-being) of care and is therefore of use as a tool to evaluate quality of care. This study aims to assess, through DCM, the experience of dementia care provision in residential and nursing homes in two voluntary organizations in England. The data illustrates similarities in the well-being and behaviour patterns of 76 persons with dementia living in six care settings throughout England. Examples of instances when people with dementia were "put down" and when well-being was enhanced, are outlined. The homes in the study were meeting the physical care but not the broader psychosocial care needs of the observed residents. The action taken by the organizations as a result of the DCM evaluations is summarized.

Yes<br>The reuse of existing datasets to identify mechanisms for improving healthcare quality has been widely encouraged. There has been limited application within dementia care. Dementia Care Mapping (DCM) is an observational tool in widespread use, predominantly to assess and improve quality of care in single organisations. DCM data has the potential to be used for secondary purposes to improve quality of care. However, its suitability for such use requires careful evaluation. This study conducted in-depth interviews with 29 DCM users to identify issues, concerns and challenges regarding the secondary use of DCM data. Data was analysed using modified Grounded Theory. Major themes identified included the need to collect complimentary contextual data in addition to DCM data, to reassure users regarding ethical issues associated with storage and reuse of care related data and the need to assess and specify data quality for any data that might be available for secondary analysis.<br>This study was funded by the Faculty of Health Studies, University of Bradford.

No<br>Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. There is growing emphasis on sharing and reusing dementia care-related datasets to improve the quality of dementia care. Consequently, there is a need to develop data management solutions for collecting, integrating and storing these data in formats that enhance opportunities for reuse. Dementia Care Mapping (DCM) is an observational tool that is in widespread use internationally. It produces rich, evidence-based data on dementia care quality. Currently, that data is primarily used locally, within dementia care services, to assess and improve quality of care. Information-rich DCM data provides opportunities for secondary use including research into improving the quality of dementia care. But an effective data management solution is required to facilitate this. A rationale for the warehousing of DCM data as a technical data management solution is suggested. The authors also propose a data model for a DCM data warehouse and present user-identified challenges for reusing DCM data within a warehouse.

RESUMO: O envelhecimento populacional é uma realidade mundial e Portugal é um dos países mais envelhecidos, situação agravada pela baixa natalidade. O envelhecimento constitui o principal fator de risco para desenvolver demência. Segundo a ADI (2015) atualmente vivem cerca de 46 milhões de pessoas com demência em todo o mundo e em Portugal estima-se que cerca de 6% das pessoas com mais de 60 anos têm um diagnóstico de demência. Em 2012 a OMS, face aos números e à sobrecarga que a síndrome representa para todos (desde a própria pessoa, seus familiares e sistemas sociais e de saúde nacionais) reconheceu a demência como uma prioridade de saúde pública, recomendando que cada País desenvolvesse e implementasse Planos Estratégicos Nacionais para a demência, o que, até à data, não aconteceu em Portugal. A elevada prevalência de pessoas com demência também se reflete nas Instituições Residenciais para as Pessoas Idosas e a pressão para que se operem mudanças ao nível da prestação de cuidados nestas instituições é crescente, mas o estigma e a imagem negativa que lhes estão associadas ainda persistem. E as exigências específicas para a prestação de cuidados de qualidade às pessoas com demência ainda estão longe de ser cumpridas na totalidade. Globalmente a Abordagem centrada na pessoa com demência é aceite como sendo sinónimo de prestação de cuidados de qualidade às pessoas com demência, no entanto em Portugal ainda não está divulgada, nem amplamente implementada. O objetivo geral desta pesquisa consiste em analisar a influência de variáveis individuais e organizacionais nos níveis de bem-estar observados em pessoas com demência que residem em instituições de modo a elaborar um modelo preditivo de bem-estar de pessoas com demência em instituição e dessa forma contribuir para a melhoria dos cuidados prestados às pessoas com demência. Esta investigação é constituída por dois estudos: Estudo I – Construção de um Questionário de caracterização das Estruturas Residenciais para a Pessoa Idosa segundo a Abordagem centrada na pessoa com demência e Estudo II – Estudo transversal observacional para observação e análise do bem-estar de pessoa com demência em 8 Unidades residências de Lisboa e Vale do Tejo, através do Dementia Care Mapping (DCM). Resultados: Estudo I – 266 ERPI responderam ao estudo o que correspondeu a uma taxa de respostas de 13%.Em média cada ERPI tem 44 residentes e cerca de 28% da totalidade dos residentes apresenta alguma forma de demência. A grande maioria das ERPI não promove formação específica em demência, todas têm quartos individuais e a quase totalidade afirma realizar avaliação inicial. No que diz respeito às necessidades psicológicas das pessoas com demência, as Unidades de Cuidados Continuados apresentaram melhores scores nas necessidades de Identidade, Inclusão e Conforto. Estudo II – A média dos níveis de bem-estar dos participantes era de 0,6 (sendo que o valor 1 corresponde ao humor neutro).Encontrámos uma correlação significativa entre os níveis de burnout dos profissionais e os níveis de bem-estar as pessoas com demência, quanto maior o burnout, menor o bem-estar. Foi encontrado um Modelo ajustado à realidade a partir do programa AMOS, modelo este, preditor do bem-estar das pessoas com demência em Estruturas Residenciais para a Pessoa Idosa. Conclusões: As Estruturas Residenciais para a Pessoa Idosa ainda apresentam algumas características asilares (grandes dimensões, muitos residentes, cuidados pouco personalizados e gestão muito rígida) e isto influencia negativamente o bem-estar das pessoas com demência. Este estudo dá pistas sobre a importância de implementar cuidados centrados na pessoa com demência nas Estruturas Residenciais para a Pessoa Idosa, de forma a melhorar o bem-estar das pessoas, apesar da demência.<br>ABSTRACT: Ageing is a global reality and Portugal is one of the most ageing country, and with very low fertility rates. Ageing is the main risk factor for developing dementia .According ADI (2015) nowadays 46 million people are living with dementia all over the world and in Portugal its estimated that 6% of the people over 60 have a diagnose of dementia. In 2012 WHO, facing dementia numbers and the overload that it represents for everyone (the person himself, their family and social and health, national systems) declared dementia as a public health priority, recommending on the same time countries to develop national strategic plans for dementia. que, until now, that didn´t happen in Portugal. The high prevalence of people with dementia also reflects on Residential Care facilities and the pressure for changing the way the care is delivered in these institutions is growing, but the stigma and the negative image that are associated with these Units still persist. The specific demands for quality care for people with dementia are still far from being a reality. Globally Person centered Care is acknowledge as quality care, but in Portugal this approach it’s not very well known or has been implemented in a wider way. Our goal was to analyze the influence of the individuals and organizational variables on the wellbeing levels of people with dementia residents at Residential Care Facilities for the elderly people in order to build a predictive model of wellbeing of people with dementia.The research has two studie : Estudy I : Questionnaire of characterization of the Residential Care Facilities for the elderly people in Portugal according to the Person Centered Care Approach and Study II : Transvers and observational Study for observing and analyzing de wellbeing of 50 people with dementia residents of 8 Facilities from Lisbon area, using Dementia Care Mapping (DCM). Results: Study I – 266 Facilities replied to the questionnaire, which is a 13% response rate. In average, each Residential Care Facility has 44 residents, from these 28% has some form of dementia. The majority of the Residential Care Facilities do not promote dementia training, all have private rooms and almost all declare to do an initial assessment of the person. Regarding the psychological needs of people with dementia, Units of Continuity of Care has higher scores in Identity, Inclusion and Comfort. Study II – In average the participants of this study had a level of wellbeing of 0,6 ( considering that +1 is neutral humor).We found a significance correlation between staff burnout levels and wellbeing levels of people with dementia, higher burnout levels correlates with lower wellbeing levels. We succeeded in building a Model that is predictor of the wellbeing of people with dementia, using AMOS software. Conclusions: Residential Care Facilities for the elderly people in Portugal still have a lot in common with the old asylums (they are big, a lot of residents, care it’s not personalized, and rigid management) and this has a negative influence in the wellbeing of people with dementia. This study gives some clues on the importance of implementing person centered care for people with dementia, as a way to improve their wellbeing.

No<br>Introduction Dementia Care Mapping (DCM) was originally developed as a clinical tool but has attracted interest as a potential observational measure of quality of life (QOL) and well-being of long-term care residents with dementia. DCM coding involves continuous observation over a 6-h period, with observers recording a Behavior Category Code (BCC, a recording of activity/interaction) and a Well/Ill Being (WIB) score at 5 min intervals. Method Descriptive data from several different research teams on the distribution and psychometric properties of DCM data were compiled and summarized. Results Issues and problems identified include: complex scoring algorithms, inter-rater reliability of the BCCs, limited variability of WIB values, associations between resident characteristics and DCM assessments, rater time burden, and comparability of results across study settings. Conclusions Despite the identified limitations, DCM has promise as a research measure, as it may come closer to rating QOL from the perspective of persons with dementia than other available measures. Its utility will depend on the manner in which it is applied and an appreciation of the measure's strength and limitations. Possible changes that might improve the reliability, validity, and practicality of DCM as a research tool include coding the predominant event (rather than the best event), shortening the observation period, and adding 0 as a neutral WIB coding option.

Yes<br>This systematic review identifies and reports the extent and nature of evidence to support the use of Dementia Care Mapping as an intervention in care settings. The review was limited to studies that used Dementia Care Mapping as an intervention and included outcomes involving either care workers and/or people living with dementia. Searches were conducted in PubMed, Web of Knowledge, CINAHL, PsychINFO, EBSCO and Scopus and manually from identified articles reference lists. Studies published up to January 2017 were included. Initial screening of identified papers was based on abstracts read by one author; full-text papers were further evaluated by a second author. The quality of the identified papers was assessed independently by two authors using the Cochrane Risk of Bias Tool. A narrative synthesis of quantitative findings was conducted. We identified 6 papers fulfilling predefined criteria. Studies consist of recent, large scale, good quality trials that had some positive impacts upon care workers’ stress and burnout and benefit people with dementia in terms of agitated behaviours, neuropsychiatric symptoms, falls and quality of life. Available research provides preliminary evidence that Dementia Care Mapping may benefit care workers and people living with dementia in care settings. Future research should build on the successful studies to date and use other outcomes to better understand the benefits of this intervention.

no<br>Person-centred care can improve the well-being of patients and is therefore a key driver in healthcare developments in the UK. The current study aims to investigate the complex relationship between cognitive impairment, dependency and well-being in people with a wide range of acquired brain and spinal injuries. Sixty-five participants, with varied acquired brain and spinal injuries, were selected by convenience sampling from six inpatient clinical neuroscience settings. Participants were observed using Dementia Care Mapping – Neurorehabilitation (DCM-NR) and categorised based on severity of cognitive impairment. A significant difference in the behaviours participants engaged in, their well-being and dependency was found between the severe cognitive impairment group and the mild, moderate or no cognitive impairment groups. Dependency and cognitive impairment accounted for 23.9% of the variance in well–ill-being scores and 17.2% of the variance in potential for positive engagement. The current study highlights the impact of severe cognitive impairment and dependency on the behaviours patients engaged in and their well-being. It also affirms the utility of DCM-NR in providing insights into patient experience. Consideration is given to developing DCM-NR as a process that may improve person-centred care in neuroscience settings.

No<br>BACKGROUND: Measuring the quality of care for people using neuro-rehabilitation services is a complex area requiring reliable methods that account for variable communication abilities/cognitive functioning. Dementia Care Mapping (DCM) is an observational method widely used in dementia care to improve person-centred care, which may be usefully applied to neuro-rehabilitation settings. Evaluation is vital to determine the tool's acceptability in this setting. PURPOSE: To explore the views of staff/patients regarding whether the use of DCM is acceptable in a neuro-rehabilitation setting. METHOD: DCM was conducted on an acute neuro-rehabilitation ward. Q-methodology, a technique for extracting subjective opinions, was used with 23 staff and 10 patients on the ward to evaluate the acceptability of DCM. RESULTS: Factor analysis was performed separately for staff and patient Q-sorts. Each found a "consensus" factor where all participants indicated positive acceptability for the use of DCM. Further exploratory factors indicated that some staff/patients had additional views/concerns that were not captured by the first consensus factor. CONCLUSIONS: The results from this preliminary study are promising and indicate that DCM is potentially an acceptable tool to use in acute neuro-rehabilitation. Further research is needed to explore the acceptability of this tool more widely across neuro-rehabilitation settings. IMPLICATIONS FOR REHABILITATION: Person-centred care is widely acknowledged as being important in all care settings, including neurorehabilitation. Dementia Care Mapping was deemed to be an acceptable approach for improving the quality of person-centred care on the basis of the views of staff and patients in a neurorehabilitation ward. Dementia Care Mapping, with adaptations for neurorehabilitation settings, successfully provides an acceptable framework for measuring and improving the quality of person-centred care in this setting.

This doctoral thesis focuses on the built environment of adult day-care centers (ADCs). It presents a mixed-method empirical research on six German ADCs with the purpose of understanding the relationship between their built environment and the spontaneous activities (SAs) of their care recipients with dementia. Field observations, Space Syntax analysis and interviews are the methods of the research. They are used to analyze how the distributions and patterns of the SAs of people with dementia are in relation to the building layout, room function, social density, and spatial visibility and accessibility of the ADCs. The research results suggest that the built environment in ADCs has influence on the distributions of SAs of people with dementia. In terms of building layout, it is revealed that the central space has a gathering effect on the location of SAs. In terms of room function, it is showed that more than 90% of SAs are distributed in the living room, the dining room, and the transition area/corridor. While no correlation is observed between the social density and the SA distribution, significant positive correlations are suggested between the spatial visibility and the SA distribution, as well as the spatial accessibility and the SA distribution. Moreover, furniture location is revealed to have an effect on the SA distribution through influencing the spatial accessibility. The thesis discusses the research findings in comparison with other previous studies. In addition, practical recommendations for design of ADCs for people with dementia are provided with examples and illustrations.<br>Die vorliegende Dissertation gibt einen Einblick in die architektonischen Merkmale von Tagespflegeeinrichtungen für Senioren. Dazu wurde eine empirische Studie in sechs deutschen Tagespflegeeinrichtungen durchgeführt mit dem Ziel, die Beziehung zwischen gebauter Umwelt und den spontanen Aktivitäten (SAs) von Menschen mit Demenz zu verstehen. Die in der Arbeit verwendeten Methoden waren Feldbeobachtungen, Space Syntax Analysen und Interviews. Dadurch wurden Verteilung und Abläufe der SAs von Menschen mit Demenz in Bezug auf die Grundrissstruktur, Raumfunktionen, soziale Dichte, Blickbeziehung (spatial visibility) und Zugänglichkeit (spatial accessibility) der Tagespflegeeinrichtungen analysiert. Die Forschungsergebnisse deuten darauf hin, dass die Architektur von Tagespflegeeinrichtungen Einfluss auf die Verteilung von SAs von Menschen mit Demenz hat. In Bezug auf die Grundrissstruktur wird gezeigt, dass ein zentral gelegener Raum eine sammelnde Wirkung auf die Verteilung der SAs hat. Betrachtet man die Abhängigkeit der Raumfunktionen zu den Aktivitäten, so finden diese hauptsächlich (über 90 %) im Wohnzimmer, Esszimmer oder Flurbereich statt. In Bezug auf die soziale Dichte lässt sich keine Abhängigkeit erkennen, wohl aber bei der Analyse der Blickbeziehung (spatial visibility), sowie der Zugänglichkeit (spatial accessibility), hier gibt es eine positive Wechselbeziehung zu der Verteilung von SAs. Darüber hinaus zeigte sich, dass der Standort der Möbel eine Auswirkung auf die SA-Verteilung hat, da diese die Zugänglichkeit (spatial accessibility) beeinflusst wird. Die Arbeit vergleicht und diskutiert die erzielten Forschungsergebnisse mit anderen bisherigen Studien. Praktische Empfehlungen für den Entwurf von Tagespflegeeinrichtungen für Menschen mit Demenz werden anhand von Beispielen und Illustrationen am Ende der Arbeit präsentiert.

OBJECTIVE: Survey results from 161 respondents trained in dementia care mapping (DCM) in the United States and United Kingdom (82 and 79 respondents, respectively) addressed the following: (a) To what extent are mappers using DCM? (b) How satisfied are mappers with DCM? (c) What affect does DCM have on mappers' attitudes toward their dementia practice? and (d) What challenges are encountered by mappers in the use of DCM? METHOD: Analyses using odds ratios were used to make international and training-level (basic vs. advanced) comparisons. RESULTS: Differences across countries were found in use of DCM and lack of satisfaction using DCM codes. Similarities were found with positive affects of DCM on attitudes and lack of time for DCM. DISCUSSION: Differences in mappers' experiences and perceptions exist across the two countries, warranting increased attention to the cultural contexts within which mappers are situated and how these affect the implementation of DCM within a country.