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Mayer H, Wallner M. Nursing effectiveness reconsidered: Some fundamental reflections on the nature of nursing. Nurs Philos 2024; 25:e12505. [PMID: 39347583 DOI: 10.1111/nup.12505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 07/04/2024] [Accepted: 09/03/2024] [Indexed: 10/01/2024]
Abstract
Despite being considered the proverbial backbone of our healthcare systems, nursing still seems to struggle to scientifically demonstrate its contribution to care experiences and patient outcomes. This leads to erosive tendencies that threaten the development of the profession and its progress as an academic discipline. With this paper, we want to contribute to the theoretical discourse concerning the nature of nursing and the research into its effectiveness. We begin by outlining a set of prevailing paradoxes and their consequences relating to nursing and nursing research: the issue of demonstrating its unique contribution despite a clear societal mandate; a discrepancy between subjectively experienced effectiveness and objectively ascertainable effectiveness; and a mismatch between theoretical premises of nursing and task-oriented cultures in practice environments. Using an example of a seemingly simple nursing intervention, we intend to demonstrate the qualities and complexities of nursing. We further illustrate this by drawing on several of our research projects using theory-based evaluation methodologies. From these illustrative examples, we distil two insights relating to nursing interventions that we consider fundamental: the nurse, as a person, is central to its unique effectiveness; and there is always an interplay between context, intervention and its intended effect. We summarise our considerations and argue the case for conceiving research designs in alignment with theoretical premises of nursing.
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Affiliation(s)
- Hanna Mayer
- Division Nursing Science/Person-Centred Care Research, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Martin Wallner
- Division Nursing Science/Person-Centred Care Research, Karl Landsteiner University of Health Sciences, Krems, Austria
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Wallner M, Haselmayer D, Nagl-Cupal M, Eppel-Meichlinger J, Mayer H. Building a programme theory of a specialist paediatric palliative and hospice care programme: development process and methodological reflection. BMC Palliat Care 2024; 23:180. [PMID: 39033288 PMCID: PMC11264908 DOI: 10.1186/s12904-024-01492-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/21/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Paediatric palliative and hospice care aims to improve the quality of life of children with life-limiting and life-threatening conditions and their families. The number of these patients has risen significantly in recent years, resulting in an increased need for palliative care for this population. Although the need for paediatric palliative and hospice care is growing, meaningful outcome evaluation to demonstrate its effectiveness as a complex healthcare intervention is in its early stages. For complex interventions (programmes), theory-based evaluations have grown in prominence in recent years. They seek to understand how and why an intervention works by uncovering its underlying mechanisms by means of programme theory. To support both outcome evaluation in paediatric palliative care and a reflective practice of programme theorizing, we aimed to describe the construction of a programme theory for a specialist paediatric palliative and hospice care programme in Austria and to offer a reflective account of its development process. METHODS We drew on a combination of theory-based evaluation frameworks to construct a programme theory consisting of an action and a change component. Through multiple iterations, incorporating different stakeholders' perspectives and drawing on different sources of knowledge and theory, we theorized how and why the programme likely achieves its intended outcomes. RESULTS The programme theory outlines the proposed chains of events, causal mechanisms and outcomes of a specialist paediatric palliative and hospice care programme for children and families in several areas corresponding to its main conceptual tenets. Through a range of activities and interventions, the programme triggers coping and adaptation mechanisms that ultimately contribute to family and child wellbeing in physical, psychological, social, and spiritual dimensions. Established trust and partnership between children/families and healthcare professionals as well as a person-centered and family-centered approach were identified as enabling factors. CONCLUSIONS Our findings provide insights into how a specialized paediatric palliative and hospice care programme works to achieve its intended outcomes for children and families. This helps demonstrate its impact, contributing to meaningful outcome evaluation and service improvement.
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Affiliation(s)
- Martin Wallner
- Division of Nursing Science with focus on Person-Centred Care Research, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Strasse 30, Krems an der Donau, 3500, Austria.
- Faculty of Social Sciences, Department of Nursing Science, University of Vienna, Alser Strasse 23/12, Vienna, 1080, Austria.
| | - Daniela Haselmayer
- Faculty of Social Sciences, Department of Nursing Science, University of Vienna, Alser Strasse 23/12, Vienna, 1080, Austria
| | - Martin Nagl-Cupal
- Faculty of Social Sciences, Department of Nursing Science, University of Vienna, Alser Strasse 23/12, Vienna, 1080, Austria
| | - Jasmin Eppel-Meichlinger
- Division of Nursing Science with focus on Person-Centred Care Research, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Strasse 30, Krems an der Donau, 3500, Austria
| | - Hanna Mayer
- Division of Nursing Science with focus on Person-Centred Care Research, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Strasse 30, Krems an der Donau, 3500, Austria
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Eppel-Meichlinger J, Cartaxo A, Clement T, Hirt J, Wallner M, Mayer H. (How) Do We Theorize?: A Focused Mapping Review and Synthesis of Theoretical Nursing Research in the German-Speaking Area. ANS Adv Nurs Sci 2024; 47:E58-E74. [PMID: 37326962 DOI: 10.1097/ans.0000000000000498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
There are increasing discussions on theory dynamics in nursing research. We aimed at mapping the theoretical publication output by nursing researchers from the European German-speaking area. We conducted a focused mapping review and synthesis, focusing on nursing journals articles with a theory-related aim. We identified 32 eligible publications, reflecting 2% of the nursing journal articles affiliated with researchers from our target region. Twenty-one articles involved an inductive approach. Eleven articles intended to test or revise a theory. The theoretical publication output with a theory-related aim was low. Theory-building efforts were fragmented and mostly without reference to a meta-theoretical level.
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Affiliation(s)
- Jasmin Eppel-Meichlinger
- Division Nursing Science with focus on Person-Centred Care Research, Department of General Health Studies, Karl Landsteiner University of Health Sciences, Krems, Austria (Mss Eppel-Meichlinger, Cartaxo, and Clement, Mr Wallner, and Dr Mayer); Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany (Dr Hirt); Center for Dementia Care, Institute of Applied Nursing Science, Department of Health, Eastern Switzerland University of Applied Sciences, St Gallen, Switzerland (Dr Hirt); Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland (Dr Hirt); and Department of Nursing Science, University of Vienna, Vienna, Austria (Mr Wallner)
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Witzig-Brändli V, Zech L, Lange C, Adlbrecht L, Gschwend S, Mayer H, Kohler M. A self-management intervention for people with multiple sclerosis: The development of a programme theory in the field of rehabilitation nursing. EVALUATION AND PROGRAM PLANNING 2023; 99:102302. [PMID: 37167790 DOI: 10.1016/j.evalprogplan.2023.102302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 03/07/2023] [Accepted: 04/29/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND People with multiple sclerosis (PwMS) have recurrent stays in rehabilitation clinics because of progressive disease. Nurses are key players in supporting PwMS through self-management interventions. However, little is known about the effectiveness, or sustainability of nursing interventions. The aim of this study was to develop a nurse-led self-management intervention and its programme theory for PwMS in one Swiss rehabilitation clinic. METHODS On the basis of the Medical Research Council framework, we developed a theory-based programme for a nurse-led intervention. As key element of the intervention, we created a consulting guidance. RESULTS As part of the programme theory, we created a systematic plan (action model) to illustrate how contextual resources (e.g., skills of the MS nurse and responsibilities of the multidisciplinary team) need to be coordinated. The change model shows how changes in the intervention lead to the achievement of outcomes (e.g., increased self-efficacy). The consulting guidance was refined by PwMS and four Swiss MS experts. CONCLUSIONS An initial programme theory is a solid foundation for the next phases of the theory-based evaluations to refine the programme theory and sustainable implementation of the intervention.
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Affiliation(s)
- Verena Witzig-Brändli
- Eastern Switzerland University of Applied Sciences, School of Health Sciences, Institute of Applied Nursing Science, St. Gallen, Switzerland
| | - Lilian Zech
- Eastern Switzerland University of Applied Sciences, School of Health Sciences, Institute of Applied Nursing Science, St. Gallen, Switzerland; Rehabilitation Centre Valens, Valens, Switzerland
| | - Cordula Lange
- Eastern Switzerland University of Applied Sciences, School of Health Sciences, Institute of Applied Nursing Science, St. Gallen, Switzerland
| | - Laura Adlbrecht
- Eastern Switzerland University of Applied Sciences, School of Health Sciences, Institute of Applied Nursing Science, St. Gallen, Switzerland
| | | | - Hanna Mayer
- Karl Landsteiner University of Health Sciences, Department of General Health Studies, Division Nursing Science with focus on Person-Centred Care Research, Krems, Austria
| | - Myrta Kohler
- Eastern Switzerland University of Applied Sciences, School of Health Sciences, Institute of Applied Nursing Science, St. Gallen, Switzerland; Rehabilitation Centre Valens, Valens, Switzerland.
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Mayer H. [Über die Notwendigkeit eines guten theoretischen Fundaments zur Wirkungsweise pflegerischen Handelns]. Pflege 2023; 36:65-66. [PMID: 36938606 DOI: 10.1024/1012-5302/a000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Affiliation(s)
- Hanna Mayer
- Fachbereich Pflegewissenschaft, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften Krems, Österreich
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Wallner M, Mayer H, Adlbrecht L, Hoffmann AL, Fahsold A, Holle B, Zeller A, Palm R. Theory-based evaluation and programme theories in nursing: A discussion on the occasion of the updated Medical Research Council (MRC) Framework. Int J Nurs Stud 2023; 140:104451. [PMID: 36812849 DOI: 10.1016/j.ijnurstu.2023.104451] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/13/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Abstract
Developing and evaluating health interventions for the benefit of patients is notoriously difficult. This also applies to the discipline of nursing, owing to the complexity of nursing interventions. Following significant revision, the updated guidance of the Medical Research Council (MRC) adopts a pluralistic view to intervention development and evaluation, including a theory-based perspective. This perspective promotes the use of program theory, aiming to understand how and under what circumstances interventions lead to change. In this discussion paper, we reflect the recommended use of program theory in the context of evaluation studies addressing complex nursing interventions. First, we review the literature by investigating the question whether and how evaluation studies targeting complex interventions used theory and to what extent program theories may contribute to enhance the theoretical foundations of intervention studies in nursing. Second, we illustrate the nature of theory-based evaluation and program theories. Third, we argue how this may impact theory building in nursing in general. We finish by discussing which resources, skills and competencies are necessary to fulfill the demanding task of undertaking theory-based evaluations. We caution against an oversimplified interpretation of the updated MRC guidance regarding the theory-based perspective, e.g. by using simple linear logic models, rather than articulating program theories. Instead, we encourage researchers to embrace the corresponding methodology, i.e. theory-based evaluation. With the prevailing perspective of knowledge production in crisis, we might be on the verge of a paradigm shift in health intervention research. Viewed through this lens, the updated MRC guidance could lead to a renewed understanding of what constitutes useful knowledge in nursing. This may facilitate knowledge production and, thereby, contribute to improve nursing practice for the benefit of the patient.
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Affiliation(s)
- Martin Wallner
- Karl Landsteiner University of Health Sciences, Division of Nursing Science with focus on Person-Centred Care Research, Krems, Austria; University of Vienna, Vienna Doctoral School of Social Sciences, Department of Nursing Science, Vienna, Austria.
| | - Hanna Mayer
- Karl Landsteiner University of Health Sciences, Division of Nursing Science with focus on Person-Centred Care Research, Krems, Austria
| | - Laura Adlbrecht
- OST Eastern Switzerland University of Applied Sciences, Department of Health, Competence Center Dementia Care, St. Gallen, Switzerland
| | - Anna Louisa Hoffmann
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Witten, Germany; Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Anne Fahsold
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Witten, Germany; Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Bernhard Holle
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Witten, Germany; Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Adelheid Zeller
- OST Eastern Switzerland University of Applied Sciences, Department of Health, Competence Center Dementia Care, St. Gallen, Switzerland
| | - Rebecca Palm
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Witten, Germany
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Adlbrecht L, Bartholomeyczik S, Mayer H. Mechanisms of impact and contextual aspects of a dementia special care unit in long-term care: a process evaluation. BMC Geriatr 2021; 21:680. [PMID: 34876048 PMCID: PMC8650270 DOI: 10.1186/s12877-021-02637-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In long-term care, persons with dementia are often cared for in specialised facilities, which are rather heterogeneous in regard to care concepts. Little information is available on how these facilities and care concepts bring about changes in the targeted outcomes. Such knowledge is needed to understand the effects of care concepts and to consciously shape further developments. This study aimed to explore the mechanisms of impact of a specific care concept from a dementia special care unit and the contextual aspects that influence its implementation or outcomes. METHODS Using a qualitative approach to process evaluation of complex interventions, we conducted participating observations and focus groups with nurses and single interviews with ward and nursing home managers. Data were collected from two identical dementia special care units to enhance the contrasts in the analysis of two non-specialised nursing homes. We analysed the data thematically. We conducted 16 observations, three group interviews and eleven individual interviews. RESULTS We identified seven themes in three domains related to mechanisms that lead to outcomes regarding residents' and nurses' behaviour and well-being. The themes include the development of nurses' skills and knowledge, the promotion of a positive work climate, adjusted spatial structures, adjusted personnel deployment strategy "dedicated time for activities", promotion of relaxation, of engagement in activities and of engagement in social interaction of residents. The implementation and outcomes of the care concept are influenced by contextual aspects relating to the (target) population and cultural, organisational and financial features. CONCLUSIONS The study found expected and unexpected mechanisms of impact and contextual aspects. The care concept of the dementia special care unit results in higher levels of relaxation, activities, and social interaction of residents. Its implementation highly depends on the shared understanding of nursing and the skills of the nursing team. Changes in residents' characteristics result in altered effects of the concept. TRIAL REGISTRATION DRKS00011513 .
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Affiliation(s)
- Laura Adlbrecht
- Department of Nursing Science, Faculty of Social Sciences, University of Vienna, Alser Strasse 23/12, 1080, Vienna, Austria.
- Department of Health, Center for Dementia Care, Institute of Applied Nursing Sciences, FHS St. Gallen, University of Applied Sciences, Rosenbergstrasse 59, 9001, St. Gallen, Switzerland.
| | - Sabine Bartholomeyczik
- School of Nursing Science, Witten/Herdecke University, Stockumer Strasse 10, 58453, Witten, Germany
| | - Hanna Mayer
- Karl Landsteiner Private University Krems, Dr.-Karl-Dorrek-Strasse 30, 3500, Krems an der Donau, Austria
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Adlbrecht L, Nemeth T, Frommlet F, Bartholomeyczik S, Mayer H. Engagement in purposeful activities and social interactions amongst persons with dementia in special care units compared to traditional nursing homes: An observational study. Scand J Caring Sci 2021; 36:650-662. [PMID: 34291489 PMCID: PMC9540018 DOI: 10.1111/scs.13017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/05/2021] [Accepted: 06/27/2021] [Indexed: 11/28/2022]
Abstract
Background Persons with dementia spend most time of their day not engaging in activities or social interactions. A care concept of a dementia special care unit that promotes activities and social interaction through a household‐like design and individualised stimuli is studied. Aim To evaluate the main outcomes of the care concept of a dementia special care unit, namely, engagement in activities and social interactions. Methods We conducted an observational study as part of a theory‐driven evaluation. The Maastricht Daily Life Observation Tool was used to collect momentary assessments multiple times per participant, including engagement in activity, type of activity, engagement in social interaction, interaction partners, location, agitation and mood. Thirty‐three residents of the dementia special care units that implemented the care concept and 54 residents with dementia of two traditional nursing homes participated in the study, resulting in 2989 momentary assessments. Results Residents of both settings did not engage in activities or social interaction in approximately half of the observations. Compared to residents of traditional nursing homes, residents of special care units had a significantly higher chance for engagement in activities and social interaction in the afternoon but not in the morning or evening. Conclusion The care concept of the special care unit facilitated engagement but had its limitations. Further research is needed to develop and evaluate appropriate interventions to enhance engagement of persons with dementia.
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Affiliation(s)
- Laura Adlbrecht
- Department of Nursing Science, Faculty of Social Sciences, University of Vienna, Vienna, Austria.,Center for Dementia Care, Institute of Applied Nursing Sciences, Department of Health, FHS St. Gallen, University of Applied Sciences, St. Gallen, Switzerland
| | - Tamara Nemeth
- Department of Nursing Science, Faculty of Social Sciences, University of Vienna, Vienna, Austria
| | - Florian Frommlet
- Center for Medical Statistics, Informatics and Intelligent Systems, Institute of Medical Statistics, Medical University of Vienna, Vienna, Austria
| | | | - Hanna Mayer
- Department of Nursing Science, Faculty of Social Sciences, University of Vienna, Vienna, Austria
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Gilbert J, Ward L, Walter R. A labour of love: Reward and satisfaction for nurses: Findings from a grounded theory study in dementia care. DEMENTIA 2020; 20:1697-1710. [DOI: 10.1177/1471301220965557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Aim To understand nurses’ perceptions of quality nursing care in the dementia-specific care unit. As the world’s population ages, the incidence of dementia is projected to rise in tandem. The requirement for skilled, dementia-trained registered nurses who can provide quality nursing care will need to increase accordingly to meet the needs of these individuals. Extensive research has been completed on dementia nursing care in a variety of settings; however, little research has been undertaken into nurses’ perceptions of quality nursing care in the dementia-specific care unit. Understanding how registered nurses perceive quality nursing care in the dementia-specific care unit is important and provides valuable information about nursing practice in this environment for nurses and decision-makers. Gaining a better understanding of quality nursing care in this care unit may result in better nurse education and an improved patient experience. It may also assist nursing organisations, residential aged-care facilities, government bodies and nongovernment agencies that support, manage, and oversee dementia-specific care units. Method A grounded theory study was conducted to understand nurses’ perceptions of quality nursing care in dementia-specific care units. The study involved interviewing nine registered nurses working in two dementia-specific care units on the Gold Coast, Queensland. Data were collected during semi-structured interviews and analysed using both constant comparison and thematic analysis. Findings Three themes emerged from this study— Caring at the Coalface, Labour of love and the Business of Dementia Healthcare. The largest theme, Labour of love, represents the personal reward and feeling of satisfaction six nurses said they experienced when interacting with individuals living in the dementia-specific care unit. They identified and repeatedly discussed the joy and fulfilment they experienced when caring for them, and considered this to be an essential element of quality nursing care. It was evident from the data that the nurses cared very deeply about these individuals, and despite increased risks to personal safety at work, they did not want to work anywhere else. This article reports on the largest and key theme identified in the study Labour of Love.
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Adlbrecht L, Bartholomeyczik S, Hildebrandt C, Mayer H. Social interactions of persons with dementia living in special care units in long-term care: A mixed-methods systematic review. DEMENTIA 2020; 20:967-984. [PMID: 32326748 PMCID: PMC8044601 DOI: 10.1177/1471301220919937] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Special care units are a well-utilized approach in the long-term care for persons with dementia. A therapeutic goal of such settings is to provide meaningful engagement and a sense of community that is crucial for the overall quality of life. In recent years, several studies followed this notion by investigating residents' social interactions and the influence of the environment on these interactions. AIMS This review aims to synthesize the literature on the social interactions of persons with dementia living in special care units. DESIGN A mixed-methods systematic review was conducted. METHODS Literature was searched in PubMed, CINAHL, PsycINFO, the Cochrane Library and Web of Science databases. Additionally, reference lists of relevant articles were searched. Studies were screened, data were extracted and the quality was appraised. Separate syntheses were conducted for qualitative and quantitative studies, which were subsequently merged in the final mixed-methods synthesis. RESULTS In total, 18 articles were included, investigating large-scale, small-scale and homelike special care units and green care farms. Residents in special care units experience few social interactions but more than those in the comparative groups. Opportunities to interact are only marginally seized. Interactions typically occur in small groups and are facilitated by familiarity and the organizational environment. Residents mainly rely on staff members to create social interaction, for example initiating or facilitating resident-to-resident interaction. CONCLUSION Although the evidence base is increasing, it is still fragmented and built on different concepts, interventions, control groups and measurements. Nevertheless, the first conclusions suggest a positive impact of special care units on residents' social interactions. Although the review yielded a more comprehensive picture of residents' social life, further high-quality research built on a sound theoretical background is needed.
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Affiliation(s)
- Laura Adlbrecht
- Department of Nursing Science, University of Vienna, Austria
| | | | | | - Hanna Mayer
- Department of Nursing Science, University of Vienna, Austria
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