The practitioner perspective
dementia
Understanding of the practitioner perspective was derived from survey responses and interview data. Twenty-four practitioners completed an online survey. Their characteristics are summarised in Additional Table Application of CR – the benefits for people with dementia, carers and practitioners themselvesTargeting of CR – understanding what characteristics indicated that someone was likely to benefit from the approachFactors affecting delivery of CR – the importance of gaining confidence, identifying people likely to benefit, and having enough time and resources to provide a truly personalised interventionSustainability of CR – whether and how delivery of CR would continue in the future.Practitioner perceptions of the intervention were positive. Most practitioners responding to the survey (22, 92%) thought the intervention was beneficial for people with dementia and would readily recommend it. Most (20, 83%) felt the training prepared them well, felt well-supported in providing the intervention (17, 71%), and found the skills they gained useful (22, 92%). In the interviews, practitioners were consistently positive about the benefits of the intervention while acknowledging that for some people complex needs and circumstances, especially physical ill-health, could impact on effectiveness. CR both achieved specific goals and promoted wider benefits such as restoring confidence, facilitating independence, instilling hope, and reducing carer burden. Practitioners attributed benefits to the person-centred and individualised nature of the intervention, the effectiveness of the techniques, the development of self-management capability, and positive engagement of carers.Lack of time was the greatest barrier for practitioners, making it difficult to get to know the person with dementia sufficiently to deliver a personalised intervention, and in some cases leading to low attendance at supervision sessions provided by the external facilitator. The other main barrier for practitioners related to self-efficacy. Practitioners needed to develop confidence through experience of delivering CR and participating in supervision, and then access further training to enhance their skills and capacity to support others. Practitioners found it helpful to gain peer support by teaming up with other practitioners and to involve assistants or technicians in providing some of the sessions. Getting started with delivering CR could be particularly challenging, especially if there was a gap between attending training and first use of the approach. This concern was addressed in Wave 2 by asking practitioners to identify potential recruits prior to training; this proved effective in enabling CR delivery to start immediately. Considering these challenges and the general organisational context, fewer than half of the practitioners surveyed (10, 42%) believed their organisation could sustain delivery.