What matters for high-quality relationships in the dementia care triad from the perspectives of nursing home residents, their relatives and care staff: A group concept mapping study

Introduction: In nursing homes, the quality of relationships within the care triad (nursing home residents with dementia, their relatives and care staff) plays a crucial role in delivering high-quality care and promoting psychological wellbeing for all involved.
Objective: As part of the SPREAD+ consortium, this study aimed to deepen the understanding of what matters for high-quality relationships within the care triad, as perceived by nursing home residents living with dementia, their relatives and care staff themselves.
Methods: A participatory mixed-methods Group Concept Mapping study was conducted with residents (n = 13), relatives (n = 50), and care staff (n = 63). Participants contributed to one or more GCM phases: brainstorming, sorting, and rating ideas on importance (scale 1-7). Data analysis was performed using Groupwisdom® software, applying multidimensional scaling and hierarchical cluster analysis. Bridging values were calculated and considered, where lower values indicated a more distinct and well-defined concept. Results were collaboratively interpreted by the research team and participants, resulting in a concept map.
Results: The brainstorming phase generated 84 ideas, which, after sorting and rating by participants, were grouped into six clusters: 1) acknowledging the resident as a unique and valued person, 2) a warm and caring approach, 3) appreciation and openness, 4) activities and facilities, 5) a sense of belonging, and 6) effective communication between family and staff. All clusters were rated as highly important ( > 5.1) with the first cluster receiving the highest score (6.2). Both family members and staff rated the clusters similarly, reflecting a strong consensus, except for cluster 3, which staff rated slightly higher. Cluster 4 showed a particularly high bridging value of 0.95, indicating it was conceptually linked to more distant areas on the map.
Conclusion: The study identified key areas that are considered important for fostering high-quality relationships within the dementia care triad. The findings provide guidance for developing or refining psychosocial interventions to foster these relationships in nursing homes. Further research could determine which clusters should be prioritized for interventions, examine existing effective interventions, and assess how well they address the clusters identified in this study.
Keywords: dementia, relationships, long-term care, group concept mapping, dementia care triad, psychosocial needs