TY  - JOUR
A1  - Desch, Anke
A1  - Förstner, Bernd Rainer
A1  - Artmann, Jörg
A1  - Häusler, Andreas
A1  - Hauptmann, Michael
A1  - Altin, Sibel Vildan
A1  - Rapp, Michael A.
A1  - Holmberg, Christine
T1  - A theory of change of an innovation for therapeutic care and meaningful living in a German nursing home
JF  - BMC geriatrics
N2  - Background:  Demographic changes are leading to growing care needs of older people and creating a challenge for healthcare systems worldwide. Nursing homes (NHs) need to provide care for growing numbers of residents while ensuring a high-quality care. We aimed to examine an innovative NH in Germany and apply a theory of change (ToC) approach to develop a best practice model (BPM) for therapeutic care in NHs. 
Methods:  A multimethod qualitative study conducted from February to July 2021 in Germany involved interviews with 14 staff members of an innovative NH and 10 directors and care managers of other NHs. The interview guidelines included questions on nursing practices, infrastructure, resources, interprofessional collaboration, and working culture. Additional material on the participating NH (website, promotion videos, newsletters, care documentation) were collected. Contextual literature on NH culture and therapeutic care in Germany, ToC methodology, and NH culture change were reviewed. Following a question-focused analysis of all material, we generated a ToC model towards a BPM of therapeutic care and meaningful living in NHs.
Results:  were verified in interdisciplinary team meetings, with study participants and other stakeholders to establish consensus. Results The participating NH's care concept aims to improve residents' functional abilities and wellbeing as well as staff members' job satisfaction. Central components of their approach include therapeutic elements such as music and movement in all nursing activities, multidisciplinary collaboration, a broad therapy and social activity offer, the continuation of therapy in everyday activities, a focus on individual life history, values, needs, and skills, social integration into the regional community, and the creation of a meaningful living environment for residents and staff.
Conclusion:  The BPM we developed shows how a meaningful living environment can be created through therapeutic care and integrative activities. The ToC sheds light onto the contextual factors and cultural values which should be considered in the development of NH interventions. Research on not only biomedical aspects, but also psychosocial dynamics and narrative co-constructions in nursing practice should inform NH innovations. The ToC also highlights the importance of developing adequate political frameworks and infrastructures for implementing such innovative practices on a larger scale.
KW  - positive gerontology
KW  - de-institutionalization
KW  - meaning-making
KW  - therapeutic  emplotment
KW  - integrated narrative nursing
KW  - nursing home culture change
Y1  - 2022
U6  - https://doi.org/10.1186/s12877-022-03462-0
SN  - 1471-2318
VL  - 22
IS  - 1
PB  - BioMed Central
CY  - London
ER  -