Understanding dementia care in care home setting in China: An exploratory qualitative study.

Dementia education for healthcare providers has gained growing attention in China. This study aimed to explore the current dementia care practices in care home setting in China because people with dementia have increased need for residential care as the cognitive function worsens. An exploratory qualitative study was conducted among care staff and residents with dementia in four care homes in a metropolitan city in China between May and August 2019. Participant observations were conducted to understand how the care environment and activities affect residents with dementia. Care records were reviewed to explore the kind of care provided. In-depth individual interviews were conducted with a purposive sample of 15 care staff members of different ranks to clarify the care practices and understand their training needs with dementia care. Field notes of observations, nursing care records and interviews transcripts were triangulated for qualitative content analysis. The theme emerged is 'suboptimal dementia care practices'. Four categories about dementia care practices in care homes were identified: (a) care environment (hospital-like layout, inappropriate lighting, environmental noise, inappropriate use of colour and unclear signage), (b) care culture (being medical-oriented, overlooking individual uniqueness and privacy), (c) attitudes towards dementia (treating as children, being authoritative, adopting punitive approaches, trying to respect the residents and having a positive learning attitude) and (d) dementia care competence (questing for specific training and resources, questing for culturally specific practices and strengthening communication with family). Creating a dementia-friendly and enabling environment, shifting the care culture paradigm from disease-oriented to person-centred and developing culturally sensitive care practices are imperative. Dementia care education for care home staff using a systematic, comprehensive approach is fundamental to achieve these goals.