The Perspective of Nurses and Healthcare Providers on the use of Television Videos with People with Moderate to Severe Dementia

Student summary

Why This Research Matters

For decades, watching television was often dismissed in dementia care as a passive, even harmful, activity that left people staring blankly at a screen. This Canadian study, led by Lillian Hung and colleagues at the University of British Columbia's IDEA Lab and published in the Canadian Journal of Nursing Research, challenges that assumption. The researchers wanted to understand how nurses and other healthcare providers actually experience and use dementia-friendly television videos (TV videos) with people who have moderate to severe dementia in real care settings.

To find out, the team held five focus groups with 23 nurses and healthcare providers working in one long-term care home and one geriatric hospital unit in the Vancouver area. Participants spanned the care team: nurses, care aides, recreation therapists and recreation aides, rehabilitation staff (a physiotherapist and rehabilitation aides), and an administrative staff member. Both settings served culturally diverse populations, with the hospital unit supporting a broad multicultural community and the care home serving many residents of Chinese and other Asian cultural backgrounds. Before the discussions, participants watched sample dementia-friendly videos (sourced from Zinnia TV, covering topics such as nature, pets, and everyday activities) so they could speak from a shared reference point. The researchers analyzed the conversations using reflexive thematic analysis, guided by Tom Kitwood's well-known person-centred care model, which describes five core psychosocial needs: comfort, attachment, inclusion, occupation, and identity. Patient and family partners were involved throughout the analysis, which adds credibility to how the themes were interpreted.

Five main themes emerged describing how TV videos are used in practice. First, videos helped calm people experiencing emotional distress; providers described using clips of pets, travel, or sports to ease anxiety and agitation, especially for residents who could not be easily soothed through conversation alone. Second, videos helped staff form connections with residents, particularly those who were withdrawn or showed aggression. One nurse described using a familiar video as a way to get connected with the patient before attempting any care task. Third, group viewing of videos matched to shared interests helped bring people together, reducing loneliness and prompting spontaneous conversation among residents, for example when immigrant residents recognized scenes from their home country. Fourth, videos supported activities of daily living: staff described using short clips that modeled simple actions, like bringing a spoon to the mouth, to help residents complete routine self-care tasks. Fifth, videos helped people connect with their past; reminiscence-style content, such as footage of infants for a former mother or soccer footage for a lifelong fan, sometimes brought previously unresponsive residents into conversation.

Beyond the five themes, participants described three practical considerations for using videos well: matching content to a person's remaining cognitive abilities (with one-on-one viewing often working better than group viewing for more advanced dementia), learning a person's individual interests and history before choosing content, and matching videos to a person's cultural background and preferred language. Providers gave concrete examples, such as showing Spanish-language music to a Spanish-speaking resident or Chinese festival videos (for example, Dragon Boat Festival imagery) to residents from Chinese backgrounds around culturally significant holidays.

The authors concluded that these findings both support and extend Kitwood's model. The extra layer they identified, an emphasis on cultural and linguistic relevance, is not explicitly named in Kitwood's original framework, which was developed in a Western context. The study suggests a form of relational agency: a person with severe dementia may not be able to choose a video independently, but a healthcare provider who knows their history and preferences can make that choice meaningfully on their behalf.

It's important to remember what this study can and cannot tell us. It captured provider perspectives only, not the direct experiences of people living with dementia, and it reflects a first phase of a larger project in two care settings in one Canadian city. Still, for nursing students, this research offers a concrete, low-cost, non-pharmacological tool to consider adding to a person-centred dementia care toolkit, alongside a reminder that thoughtful preparation, not just pressing play, is what makes the intervention meaningful.

Faculty notes

Educational Relevance

This qualitative study by Hung and colleagues (Canadian Journal of Nursing Research, 2023) offers a timely, practice-grounded contribution to non-pharmacological dementia care literature. Using five focus groups with 23 healthcare providers (6 nurses, 6 care aides, 5 recreation aides, 2 recreation therapists/team leads, 2 rehabilitation aides, 1 physiotherapist, and 1 administration clerk) across a long-term care home and a geriatric hospital unit in the Vancouver area, the researchers examined how dementia-friendly television videos are perceived and used with people who have moderate to severe dementia. The study is methodologically notable for its use of reflexive thematic analysis guided by Kitwood's person-centred care model, with patient and family partners embedded in the analytic process across three team meetings, and data managed in NVivo.

Five themes captured the perceived function of TV videos in practice: calming emotional distress, forming connections with residents (particularly those who are withdrawn or agitated), bringing people together socially during group viewing, facilitating activities of daily living through modeled visual cues, and supporting reminiscence by connecting residents with their personal past. A further three themes described practice considerations providers said were essential to successful use: matching content to the person's remaining cognitive capacity (noting that one-on-one viewing may suit more advanced dementia better than group settings), tailoring content to individual interests and personal history, and matching content to cultural and linguistic background, illustrated by examples such as Spanish-language music for a Spanish-speaking resident and Chinese festival videos timed to cultural holidays.

For discussion, this is a strong exemplar of theory-guided qualitative analysis extending, rather than simply applying, an established framework. The authors argue their cultural/linguistic theme adds a dimension not explicit in Kitwood's original Western-developed model, an argument worth interrogating with students: is this genuinely novel, or an elaboration of Kitwood's existing identity and inclusion needs? The paper is also useful for discussing relational agency, the idea that meaningful choice for a person with severe dementia can be exercised through a knowledgeable proxy (the care provider), which has broader application across many areas of person-centred and family-centred care.

Instructors should flag several appraisal points. This is a provider-perspective study; the people living with dementia themselves were not interviewed, so claims about video benefits are provider-inferred rather than directly evidenced by patient report or validated outcome measures. The sample is drawn from two sites in one Canadian metropolitan region, limiting generalizability, particularly to rural, non-multicultural, or non-Canadian settings. As the authors note, this represents an early phase of a larger implementation project, so findings should be read as formative rather than confirmatory. There is also a risk of social desirability bias, since participants had just viewed curated sample videos immediately before discussing their benefits, which could shape enthusiasm in the focus group setting.

Practically, the study gives faculty a rich case for teaching non-pharmacological intervention design, cultural safety in care planning, and the difference between passive versus purposeful use of media technology in long-term care and hospital-based geriatric settings.