# Employed Caregivers’ Perceptions of Environmental Influences in Residential Dementia Care: A Qualitative Meta-Synthesis

## TL;DR

This study explores how caregivers in dementia care view the impact of their work environment on care quality and suggests ways to improve training and policies.

## Contribution

The study provides a qualitative meta-synthesis of caregivers’ environmental perceptions in dementia care, highlighting gaps in practice and policy.

## Key findings

- Caregivers’ perceptions of organizational structures and support influence their work environment.
- Relational and social dynamics significantly impact the lived environment for dementia care.
- Physical space and design play a crucial role in the overall care experience for individuals with dementia.

## Abstract

Background/Objectives: Understanding environmental experiences in residential dementia care is crucial for enhancing care practices, training, and policy. The environment’s role in dementia care is complex. Allied health and nursing professionals must consider environmental aspects concerning care for individuals with dementia. This study investigates how employed caregivers experience and perceive environmental influences in residential dementia care. Methods: In September 2024, we systematically searched PubMed, CINAHL, and PsycINFO for qualitative studies, adhering to SRQR guidelines. The CASP tool was used to assess study quality, ensuring rigor and reliability in selection. The meta-synthesis is registered with Prospero: CRD42024598962. A template analysis was conducted to structure emerging themes. Results: Fifteen studies met the inclusion criteria. Key themes included: 1. Working Environment: Informed understandings—capturing caregivers’ perceptions of organisational structures and support. 2. Lived Environment: Stability and Clarity—highlighting the impact of relational and social dynamics on caregiving; and 3. Physical and Built Environment: Impact on Overall Care Experience—looking at the role of space and design in facilitating effective dementia care. Following this, more subthemes emerged, resulting in the final template. Conclusions: The key gaps included understanding the existing strengths of practice, differences in job roles, funding, the role of Employed Caregivers, and Employed Caregivers’ personhood. Emphasising evidence-based practice and clearly defining job roles may improve decision-making and collaboration. It is essential to identify funding gaps and provide clear guidelines and training to ensure equitable care and maximise the contributions of Employed Caregivers working with nurses and allied health professionals. Recognising Employed Caregivers’ personhood could enhance job satisfaction and reduce burnout. Policies should address these gaps by providing training to clarify roles and enhance skills. A supportive, person-centred workplace may improve satisfaction and care outcomes. Future research should evaluate these aspects and continue to identify the best practices.