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. 2025 Feb 1;24(1):116.
doi: 10.1186/s12912-025-02726-5.

Provision of dementia-specific care in nursing homes in North Rhine-Westphalia (Germany) - analysis of person-centered practices and related problems within a holistic multiple case study

Kathrin Schmüdderich  1   2 , Anne Fahsold  3   4 , Jonas Dörner  3   4 , Martina Roes  3   4 , Rebecca Palm  4   5 , Bernhard Holle  3   4
Affiliations

Provision of dementia-specific care in nursing homes in North Rhine-Westphalia (Germany) - analysis of person-centered practices and related problems within a holistic multiple case study

Kathrin Schmüdderich et al. BMC Nurs. .

Abstract

Background: To ensure high-quality care for residents living with dementia, recommendations for dementia-specific care do exist internationally as well as in Germany. Nevertheless, it remains unclear how dementia-specific care is currently provided and what can be derived from this for the improvement of dementia-specific care. Therefore, this study aimed to investigate the provision of dementia-specific care and related problems in German nursing homes.

Methods: We used a holistic multiple case design with a total of four cases. The cases were defined as care units in which residents living with dementia were cared for. For data collection, we used problem-centered face-to-face interviews, document analysis, and context questionnaires and analyzed all qualitative data inductively and deductively using content structuring qualitative analysis. To identify case-specific and cross-case patterns and themes, we focused on similarities and differences between the cases. The reporting followed the EQUATOR reporting guideline for organizational case studies.

Results: We interviewed 21 professionals, 14 relatives and 8 residents living with dementia. Despite context-specific differences, we identified a variation of care practices and problems in applying person-centered, dementia-specific care in German nursing homes. In all cases, these belong to the following topics: 1) handling neuropsychiatric symptoms, 2) dealing with communication difficulties, 3) providing person-centered interaction and communication, 4) dealing with stress caused by experiencing dementia-specific symptoms and 5) using and sharing knowledge. Even though the problems were identified in all cases, we also found differences in the extent and perception of these problems across the analyzed cases.

Discussion: Despite existing conceptual recommendations and described care practices in our study, the identified problems showed that current care practices are perceived as problematic and partly are not person-centered. This highlights that person-centered requirements in dementia-specific care are not yet adequately addressed and that there is a need to give greater consideration to the identified problems when developing interventions to improve quality of care. Furthermore, the identified context-specific differences in the extent and perception of these problems show that the designs of new care models should allow for more flexibility, so that written recommendations can be implemented in practice and adapted to given contexts.

Keywords: Advancing nursing care; Case studies; Delivery of healthcare; Dementia-specific care; Needs assessment; Person-centered care; Qualitative research; Residential facilities.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: We obtained ethical approval from the German Society of Nursing Science (DGP e. V.) (Registration No. 21–032). In accordance with ethical guidelines, participation in the study was voluntary, and written informed consent was obtained from all participants or their legal representatives prior to data collection. Additionally, ongoing consent was obtained from residents living with dementia before and during the interviews. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Characteristics of the participants included in each case
Fig. 2
Fig. 2
Identified care practices and related problems
See this image and copyright information in PMC

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