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Chatwin J, Ludwin K, Jones D, Bravington A. Understanding interaction in problematic dementia and social care encounters: Protocol for a micro-level study combining video-ethnography and Conversation Analysis (CA). PLoS One 2024; 19:e0305069. [PMID: 38875309 PMCID: PMC11178166 DOI: 10.1371/journal.pone.0305069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 06/16/2024] Open
Abstract
INTRODUCTION It is well established that the actions and behaviour of dementia care workers are fundamental to the wellbeing of the people they care for. Not only do they deal with basic healthcare needs, but they also perform a vital psycho-social function by providing-through their regular presence-an underlying continuity for residents. This has been shown to improve well-being, particularly for those in the advanced stages of dementia. It has also been suggested that there are additional psycho-social benefits of such contact which can directly influence the need for anti-psychotic medication. However, unlike most other healthcare and medical settings, the specialised and often difficult interactions that dementia care workers handle every day have not yet been the subject of detailed micro-level analysis. This is particularly significant because much of the impact that care-workers have relates to the way in which they interact with the people they care for. Not having a clear understanding of how their interactions 'work' at the micro-level-particularly ones that are specific to dementia care settings, and that care workers report to be difficult or challenging-means that any training interventions that are developed may not resonate with their real-world experience, and ultimately run the risk of failing. This video-based observational study aims to provide a detailed micro-exploration of problematic and challenging interactions involving care-workers and people living with dementia. SETTING AND METHODS The study is based in the UK and will involve up to 20 dementia care staff and 60 people living with dementia. Fieldwork will be conducted in 5 dementia care home and community-based dementia day care settings using naturalistic observational methods (primarily video-ethnography). Data will be analysed using Conversation Analysis (CA).
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Affiliation(s)
- John Chatwin
- Midlands Partnership NHS Foundation Trust, Hebden Bridge, United Kingdom
| | - Katherine Ludwin
- Midlands Partnership NHS Foundation Trust, Hebden Bridge, United Kingdom
| | - Danielle Jones
- Centre for Applied Dementia Studies, University of Bradford, Bradford, United Kingdom
| | - Alison Bravington
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston upon Hull, United Kingdom
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Dhanda N, Pryce H. An ethnography study exploring factors that influence social isolation in care home residents living with dementia and hearing loss. BMC Geriatr 2023; 23:593. [PMID: 37749500 PMCID: PMC10518931 DOI: 10.1186/s12877-023-04296-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/08/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Hearing loss and dementia are highly prevalent conditions amongst older adults living in residential care. The consequences of living with these conditions may include social withdrawal and reduced communication opportunities. We sought to examine patterns of communication and interaction in residential care and explore resident, staff, and relative perspectives within two care homes located in Birmingham, UK. This enabled an understanding of how communication environments contributed to social isolation. METHODS This work used ethnography methodology to explore mechanisms that created and maintained social isolation in older adults living with dementia and hearing loss. A planning and engagement phase took place in four care homes. This was followed by an environmental audit, observations, and interviews. Data generated were analysed using Grounded Theory methods. RESULTS There were 33 participants (16 residents, 11 care staff, and six relatives) who took part in the observations and interviews. Residents experienced social isolation through lack of meaningful conversation with others and being misunderstood. Additionally, observations of residents' interactions informed the overall findings. A Grounded Theory model was employed to explain the core phenomenon of social isolation. The main contributors were internal and external barriers to communication, and reduced opportunities for meaningful conversation. CONCLUSIONS There is a wide range of social isolation that care home residents experience. This was not always associated with the severity of hearing loss but rather communication ability. Simple interventions such as staff dining with residents and focussing on improving communication could reduce social isolation within residential care settings.
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Affiliation(s)
- Nisha Dhanda
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- University of Birmingham Dubai, Dubai International Academic City, PO Box 341799, United Arab Emirates.
| | - Helen Pryce
- College of Health and Life Sciences, Aston University, Birmingham, UK
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Leppla I, Tobolowsky W, Patel S, Mahdanian A, Lobner K, Caufield-Noll C, Ponor IL, Roy D. Scoping Review on Educational Programs for Medical Professionals on the Management of Acute Agitation. J Acad Consult Liaison Psychiatry 2023; 64:457-467. [PMID: 37211211 DOI: 10.1016/j.jaclp.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/09/2023] [Accepted: 05/14/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Agitation is a common reason for psychiatric consultation in the general hospital. The consultation-liaison (CL) psychiatrist is often tasked with teaching the medical team how to manage agitation. OBJECTIVE The purpose of this scoping review is to explore what resources the CL psychiatrist has for educational tools on teaching about agitation management. Given the frequency with which CL psychiatrists help with on-the-ground management of agitation, we hypothesized that there would be a scarcity of educational resources to teach front-line providers how to manage agitation. METHODS Following current Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a scoping review was conducted. The literature search focused on the electronic databases MEDLINE (PubMed), Embase (Embase.com), The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), PsycInfo (EbscoHost), Cumulated Index to Nursing and Allied Health Literature (CINAHL) (EbscoHost), and Web of Science. Using Covidence software, after screening for titles and abstracts, full texts were screened independently and in duplicate according to our inclusion criteria. For data extraction, we created a predefined set of criteria according to which each article was analyzed. We then grouped the articles in the full-text review according to which patient population a curriculum was designed for. RESULTS The search yielded a total of 3250 articles. After removing duplicates and reviewing procedures, we included 51 articles. Data extraction captured article type and details; educational program information (staff training, web modules, instructor led seminar); learner population; patient population; and setting. The curricula were further divided based on their target patient population, specifically the acute psychiatric patient (n = 10), the general medical patient (n = 9), and the patient with a major neurocognitive disorder such as dementia or traumatic brain injury (n = 32). Learner outcomes included staff comfort, confidence, skills, and knowledge. Patient outcomes included measurements of agitation or violence using validated scales, PRN medication use, and restraint use. CONCLUSIONS Despite there being numerous agitation curricula in existence, we found that a large majority of these educational programs were done for patients with major neurocognitive disorders in the long-term care setting. This review highlights the gap in education related to agitation management for both patients and providers in the general medical setting, as less than 20% of total studies are focused on this population. The CL psychiatrist plays a critical role in assisting in agitation management in this setting, which often requires collaboration between technicians, nurses, and nonpsychiatric providers. It calls into question whether the lack of educational programs makes the implementation of management interventions more difficult and less effective, even with the assistance of the CL psychiatrist.
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Affiliation(s)
- Idris Leppla
- Johns Hopkins School of Medicine, Baltimore, MD; Johns Hopkins Psychiatry & Behavioral Sciences, Baltimore, MD.
| | - William Tobolowsky
- Johns Hopkins School of Medicine, Baltimore, MD; Johns Hopkins Psychiatry & Behavioral Sciences, Baltimore, MD
| | | | - Artin Mahdanian
- Johns Hopkins School of Medicine, Baltimore, MD; Johns Hopkins Psychiatry & Behavioral Sciences, Baltimore, MD
| | | | | | - I Lucia Ponor
- Johns Hopkins School of Medicine, Baltimore, MD; Johns Hopkins Department of Medicine, Baltimore, MD
| | - Durga Roy
- Johns Hopkins School of Medicine, Baltimore, MD; Johns Hopkins Psychiatry & Behavioral Sciences, Baltimore, MD
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Kim S, Liu W. Psychometric Properties of Instruments Measuring Dyadic Communication and Environment in Dementia Care: A Systematic Review. THE GERONTOLOGIST 2023; 63:52-70. [PMID: 34864998 DOI: 10.1093/geront/gnab178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES A valid and reliable assessment of dementia dyadic communication and environment is essential to understand and facilitate social interaction and quality care. This review described the characteristics and evaluated psychometric properties of instruments that assess dyadic communication and environment between persons living with dementia and their caregivers. RESEARCH DESIGN AND METHODS A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Literature published until June 30, 2021, was searched. Ten psychometric properties and the ratio of sample size to the number of items were evaluated using the Psychometric Assessment for Self-report and Observational Tool. RESULTS A total of 3,708 scholarly records was identified, and 24 eligible instruments from 48 scholarly records were evaluated. Twenty-two instruments assessed dyadic communication, and 2 assessed both dyadic communication and environment. Eighteen instruments were developed to assess task-related communication and 15 for paid (professional) caregivers. All instruments were scored as low psychometric quality (score range = 0-7). Behavioral Observation Scoring System was scored the highest (total score = 7), followed by Dyadic Dementia Coding System, Grid for observation of physical and verbal behaviors of caregiver and resident, and Trouble-Indicating Behaviors and Repair (total score = 6). These instruments had low psychometric evidence for internal consistency, content validity, and structural validity. DISCUSSION AND IMPLICATIONS Existing instruments are in the early stages of development and validation in dementia population. Further testing is needed in diverse communication types in paid and unpaid dementia caregiver populations.
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Affiliation(s)
- Sohyun Kim
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
| | - Wen Liu
- College of Nursing, The University of Iowa, Iowa City, Iowa, USA
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Zeng BT, Jin Y, Cheng SD, Ding YM, Du JW. Administration approaches of nursing assistants in hospitals: a scoping review. BMJ Open 2022; 12:e063100. [PMID: 36428023 PMCID: PMC9703314 DOI: 10.1136/bmjopen-2022-063100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The administration of nursing assistants (NAs) is closely associated with patient outcomes, but studies evaluating intrahospital administration of NAs are limited. This study aimed to identify existing literature on intrahospital NAs' administration approaches. DESIGN Scoping review. DATA SOURCES PubMed, Embase, CINAHL, Scopus, ProQuest, CNKI, APA PsycInfo, Wanfang Med, SinoMed, Ovid Emcare, NICE, AHRQ, CADTH, JBI EBP and Cochrane DSR were searched for articles published between January 2011 and March 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Qualitative, quantitative or mixed-method studies and evidence syntheses that evaluate administration approaches, models and appraisal tools of intrahospital NAs were included. DATA EXTRACTION AND SYNTHESIS Two independent reviewers conducted search, data selection and data extraction according to Joanna Briggs Institute guidance and methodology for scoping review. The quality of included studies was assessed using Mixed Methods Appraisal Tool or AMSTAR V.2. Data were synthesised using narrative methods and frequency effect size analysis. RESULTS Thirty-six studies were eligible, with acceptable quality. We identified 1 administration model, 9 administration methods, 15 educational programmes and 7 appraisal tools from the included studies. The frequency effect size analysis yielded 15 topics of the main focus at four levels, suggesting that included articles were mainly (33%) focused on the competency of NAs, and the lectures were the most (80%) used strategy in quality improvement projects. Evidence from the studies was of low-to-moderate quality, indicating huge gaps between evidence-based research and management practice. CONCLUSIONS Practical intrahospital administration approaches were revealed, and fifteen primarily focused topics were identified. We should explore this area more thoroughly using structured frameworks and standardised methodology. This scoping review will help managers find more effective ways to improve the quality of care. Researchers may focus more on evidence-based practice in NA administration using the 15 topics as a breakthrough.
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Affiliation(s)
- Ben-Tuo Zeng
- School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yinghui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Shu-Dong Cheng
- Nursing Department, Xiang'an Hospital of Xiamen University, Xiamen, Fujian, China
| | - Yan-Ming Ding
- Nursing Department, Peking University First Hospital, Beijing, China
| | - Ji-Wei Du
- Nursing Department, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
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Paudel A, Galik E, Resnick B, Doran K, Boltz M, Zhu S. Pilot Testing of the Promoting Positive Care Interactions Intervention in Assisted Living. J Gerontol Nurs 2022; 48:17-25. [PMID: 35914082 DOI: 10.3928/00989134-20220629-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The current study aimed to test the feasibility and preliminary efficacy of the Promoting Positive Care Interactions (PPCI) intervention designed to establish positive care interactions between staff and residents in assisted living (AL) using an online approach. PPCI was implemented in one AL community using a single group pre-/posttest design; 17 care staff were recruited from the memory care unit. Delivery, receipt, and enactment of the PPCI were assessed for feasibility. Change in staff outcomes and facility outcomes were examined for preliminary efficacy. The four steps of the PPCI were implemented as intended with 100% staff exposure to education and considerable staff engagement in weekly mentoring sessions. Although there was an improvement in AL environment and policy, no significant changes were observed in staff outcomes. Future testing of the PPCI should include a longer timeline and explore a hybrid model that includes online education and in-person mentoring and coaching of staff to improve care interactions. [Journal of Gerontological Nursing, 48(8), 17-25.].
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Sefcik JS, Boltz M, Dellapina M, Gitlin LN. Are Interventions for Formal Caregivers Effective for Improving Dementia Care? A Systematic Review of Systematic Reviews. Innov Aging 2022; 6:igac005. [PMID: 35496650 PMCID: PMC9042653 DOI: 10.1093/geroni/igac005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background and Objectives Several systematic reviews exist that examine the efficacy of educational interventions in randomized controlled trials (RCTs) designed to improve formal caregivers' knowledge and skills and/or the outcomes of persons living with dementia. The aim of this article is to summarize existing systematic reviews to assess the effectiveness of educational interventions tested in RCTs and directed at formal caregivers. Research Design and Methods Smith et al.'s methodology guided this systematic review of systematic reviews. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2) for quality appraisals. Reviews were included if they contained interventions with an RCT design that focused on changing staff behavior and/or practice toward persons living with dementia, in any setting and for any health care discipline. Results We identified six systematic reviews, one rated as high-quality on the AMSTAR 2. Most interventions were directed at nursing staff, in long-term care facilities, focused on agitation, and were atheoretical. There is insufficient evidence to guide implementation of currently tested interventions; however, training in communication skills, person-centered care, and dementia-care mapping with supervision show promise for improving agitation. Discussion and Implications There's a critical need for additional research with well-designed RCTs, and clear reporting of protocols and findings to inform the field on how best to train and support the workforce. Although there is no conclusive evidence on what interventions are most effective, it could be argued that providing training using interventions with modest evidence of impact is better than no training at all until the evidence base is strengthened.
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Affiliation(s)
- Justine S Sefcik
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Marie Boltz
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Maria Dellapina
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
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Song Y, Mohamed Nassur A, Rupasinghe V, Haq F, Boström AM, Reid C, Andersen E, Wagg A, Hoben M, Goodarzi Z, Squires JE, Estabrooks CA, Weeks LE. Factors associated with residents’ responsive behaviours towards staff in long-term care homes: A systematic review. THE GERONTOLOGIST 2022; 63:674-689. [PMID: 35094085 PMCID: PMC10167766 DOI: 10.1093/geront/gnac016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Objectives
When staff experience responsive behaviors from residents, this can lead to decreased quality of work-life and lower quality of care in long-term care homes. We synthesised research on factors associated with resident responsive behaviours directed towards care staff and characteristics of interventions to reduce the behaviours.
Research Design and Methods
We conducted a mixed-methods systematic review with quantitative and qualitative research. We searched 12 bibliographic databases and “grey” literature, using two keywords (long-term care, responsive behaviours) and their synonyms. Pairs of reviewers independently completed screening, data extraction, and risk of bias assessment. We developed a coding scheme using the ecological model as an organising structure and prepared narrative summaries for each factor.
Results
From 86 included studies (57 quantitative, 28 qualitative, 1 mixed methods), multiple factors emerged, such as staff training background (individual level); staff approaches to care (interpersonal level); leadership and staffing resources (institutional level); and racism and patriarchy (societal level). Quantitative and qualitative results each provided key insights, such as qualitative results pertaining to leadership responses to reports of behaviours, and quantitative findings on the impact of staff approaches to care on behaviours. Effects of interventions (n=14) to reduce the behaviours were inconclusive.
Discussion and Implications
We identified the need for enhanced understanding of the interrelationships among factors associated with resident responsive behaviours towards staff and processes leading to the behaviours. To address these gaps and to inform theory-based effective interventions for preventing or mitigating responsive behaviours, we suggest intervention studies with systematic process evaluations.
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Affiliation(s)
- Yuting Song
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | | | | | - Fajr Haq
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anne-Marie Boström
- Department of Neurobiology, Care Sciences, and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Colin Reid
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Elizabeth Andersen
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Zahra Goodarzi
- Department of Medicine, University of Calgary, Calgary Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary Alberta, Canada
| | - Janet E Squires
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Lori E Weeks
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
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Vitale E, Giammarinaro MP, Lupo R, Archetta V, Fortunato RS, Caldararo C, Germini F. The quality of patient-nurse communication perceived before and during the COVID-19 pandemic: an Italian pilot study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021035. [PMID: 34328139 PMCID: PMC8383229 DOI: 10.23750/abm.v92is2.11300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/02/2021] [Indexed: 02/03/2023]
Abstract
Background and Aim of the work. Therapeutic communication is essential for assessing the quality of patients’ care. The present study aimed to assess how the forced use of the mask influenced the communication before and during the Covid-19 pandemic. Methods. An online questionnaire was administered including two socio-demographic items, such as sex, as male and female, and role, as nurse or patient, and the Quality of Communication Questionnaire (QOC) for twice, referring to the period before and during the pandemic. Results. 178 subjects participated in the study, of which 60 (33.7%) were patients and 118 (66.3%) were nurses. During the pandemic, patients reported no significant differences in the perception of the quality of nurse-patient communication. While nurses recorded a lower perception of communication quality during the pandemic period than before. Conclusions. The patient willingly accepted the use of the face mask unlike nurses considered it a further obstacle to an effective communication between nurse-patient. However, it could be considered the emotional and caring overload that each nurse had stored during the Covid-19 pandemic, in addition to the fear of contagion that had gripped the lives of nurses on a daily basis.
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Affiliation(s)
- Elsa Vitale
- Department of Mental Health, Local Health Authority Bari, Italy.
| | | | - Roberto Lupo
- San Giuseppe da Copertino hospital, Lecce, Italy.
| | | | | | | | - Francesco Germini
- Direction of Health Professions, Local Healthcare Company Bari, Italy.
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Chu CH, McGilton KS, Spilsbury K, Le KN, Boscart V, Backman A, Fagertun A, Devi R, Zúñiga F. Strengthening International Research in Long-Term Care: Recommended Common Data Elements to Support Clinical Staff Training. Gerontol Geriatr Med 2021; 7:2333721421999312. [PMID: 33718524 PMCID: PMC7923973 DOI: 10.1177/2333721421999312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 12/19/2022] Open
Abstract
The purpose of this study is to develop candidate common data element (CDE) items related to clinical staff training in long-term care (LTC) homes that can be used to enable international comparative research. This paper is part of the WE-THRIVE (Worldwide Elements to Harmonize Research in Long-Term Care Living Environments) group's initiative which aims to improve international academic collaboration. We followed best practices to develop CDEs by conducting a literature review of clinical staff (i.e., Regulated Nurses, Health Care Aides) training measures, and convening a subgroup of WE-THRIVE experts to review the literature review results to develop suitable CDEs. The international expert panel discussed and critically reflected on the current knowledge gaps from the literature review results. The panel proposed three candidate CDEs which focused on the presence of and the measurement of training. These three proposed CDEs seek to facilitate international research as well as assist in policy and decision-making regarding LTC homes worldwide. This study is a critical first step to develop candidate CDE items to measure staff training internationally. Further work is required to get feedback from other researchers about the proposed CDEs, and assess the feasibility of these CDEs in high and low resourced settings.
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Affiliation(s)
- Charlene H Chu
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Katherine S McGilton
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | | | - Kim N Le
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Veronique Boscart
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Conestoga College Institute of Technology and Advanced Learning, Kitchener, ON, Canada
| | | | - Anette Fagertun
- Western Norway University of Applied Sciences, Bergen, Vastland, Norway
| | | | - Franziska Zúñiga
- Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
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Pinazo-Clapés C, Pinazo-Hernandis S, Sales A. Effects of an Educational Program for Professional Caregivers on Behavioral Alterations in Nursing Home Residents: Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8845. [PMID: 33260699 PMCID: PMC7731200 DOI: 10.3390/ijerph17238845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/21/2020] [Accepted: 11/24/2020] [Indexed: 11/25/2022]
Abstract
This pilot study aims to analyze the effectiveness of a type of non-pharmacological intervention such as the educating and training of professional caregivers on behavioral alterations and prescription of psychotropic drugs of older adults in nursing homes. One hundred and forty-five people from two nursing homes were randomized to either treatment (educational training program for healthcare professionals) or a no-treatment group. Twenty-two professional caregivers in the experimental group received 20 h of a training program. Five data collection points were collected (pre and post, and three follow-ups, all six months apart). Intervention consisted of the behavioral alterations and psychopharmacological treatment. The analysis of variance for repeated measures showed significant differences in the time-group interaction for the educational program's effectiveness in reducing behavior alterations and psycho-pharmaceuticals' record. The results show that an improvement in the educating and training of professional caregivers can reduce behavioral alterations (F3,407 = 9.29, p < 0.001, η2= 0.063) and prescription of psychotropic drugs (F2,10 = 18.90, p < 0.001, η2 = 0.117). In addition, these effects are maintained over time. Educating health professionals on ways to care for residents who present behavioral alterations may be one alternative for improving the quality of care that residents receive. Non-pharmacological interventions, besides being individualized and adapted to the needs and experiences of individuals, achieve effects that last longer at low cost. An educational program shows new alternatives to pharmacological intervention, achieving a reduction in behavioral alterations without the costs and effects that psychopharmaceuticals entail.
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Affiliation(s)
| | | | - Alicia Sales
- Department of Developmental Psychology, Faculty of Psychology, University of Valencia, 46010 Valencia, Spain
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Piau A, Vautier C, De Mauleon A, Tchalla A, Rumeau P, Nourhashemi F, Soto-Martin M. Health workers perception on telemedicine in management of neuropsychiatric symptoms in long-term care facilities: Two years follow-up. Geriatr Nurs 2020; 41:1000-1005. [PMID: 32771311 PMCID: PMC7406447 DOI: 10.1016/j.gerinurse.2020.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 11/18/2022]
Abstract
The management of neuropsychiatric symptoms is a challenge in long-term care facilities. Our objective was to assess the perception of telemedicine, as a useful tool to connect staff to specialized units. In this multicenter prospective study, 90 patients from ten facilities benefited from 180 sessions over two years. The primary outcome was the perception of telemedicine evaluated through semi-structured interviews at baseline and two years later. Our results revealed positive perceptions of telemedicine, confirmed after two years of real-life experience with its use. Not only do staff members believe that telemedicine is not a downgraded version of medicine, but they also believe that it could improve the quality of care. They expressed a very positive sense of recognition of their professional qualifications and indicated their need to be involved in change processes to ensure successful implementation and better adherence to telemedicine as a service.
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Affiliation(s)
- Antoine Piau
- Gérontopôle, CHU Toulouse, F-31400 Toulouse, France; UMR 1027, INSERM, F-31400 Toulouse, France.
| | - Claude Vautier
- Université des Sciences Sociales-Toulouse 1, Manufacture des Tabacs 2, rue du Doyen Gabriel Marty, 31042 Toulouse, France
| | | | - Achille Tchalla
- Université de Limoges, IFR 145 GEIST, EA 6310 HAVAE, Limoges, F-87025, France
| | | | - Fati Nourhashemi
- Gérontopôle, CHU Toulouse, F-31400 Toulouse, France; UMR 1027, INSERM, F-31400 Toulouse, France
| | - Maria Soto-Martin
- Gérontopôle, CHU Toulouse, F-31400 Toulouse, France; UMR 1027, INSERM, F-31400 Toulouse, France
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Ballard C, Orrell M, Moniz-Cook E, Woods R, Whitaker R, Corbett A, Aarsland D, Murray J, Lawrence V, Testad I, Knapp M, Romeo R, Zala D, Stafford J, Hoare Z, Garrod L, Sun Y, McLaughlin E, Woodward-Carlton B, Williams G, Fossey J. Improving mental health and reducing antipsychotic use in people with dementia in care homes: the WHELD research programme including two RCTs. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08060] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
The effective management of agitation and other neuropsychiatric and behavioural symptoms in people with dementia is a major challenge, particularly in care home settings, where dementia severity is higher and there is limited training and support for care staff. There is evidence for the value of staff training and the use of psychosocial approaches; however, no intervention currently exists that combines these elements into an intervention that is fit for purpose and effective in these settings based on evidence from a randomised controlled trial.
Objective
The objective was to develop and evaluate a complex intervention to improve well-being, reduce antipsychotic use and improve quality of life in people with dementia in care homes through person-centred care, management of agitation and non-drug approaches.
Design
This was a 5-year programme that consisted of six work packages. Work package 1 consisted of two systematic reviews of personalised psychosocial interventions for behavioural and psychological symptoms for people with dementia in care homes. Work package 2 consisted of a metasynthesis of studies examining implementation of psychosocial interventions, in addition to developing a draft Well-being and Health for people with Dementia (WHELD) programme. Work package 3 consisted of a factorial study of elements of the draft WHELD programme in 16 care homes. Work package 4 involved optimisation of the WHELD programme based on work package 3 data. Work package 5 involved a multicentre randomised controlled trial in 69 care homes, which evaluated the impact of the optimised WHELD programme on quality of life, agitation and overall neuropsychiatric symptoms in people with dementia. Work package 6 focused on dissemination of the programme.
Setting
This programme was carried out in care homes in the UK.
Participants
Participants of this programme were people with dementia living in care homes, and the health and care professionals providing treatment and care in these settings.
Results
Work package 1: reviews identified randomised controlled trials and qualitative evidence supporting the use of psychosocial approaches to manage behavioural symptoms, but highlighted a concerning lack of evidence-based training manuals in current use. Work package 2: the meta-analysis identified key issues in promoting the use of interventions in care homes. The WHELD programme was developed through adaptation of published approaches. Work package 3: the factorial trial showed that antipsychotic review alone significantly reduced antipsychotic use by 50% (odds ratio 0.17, 95% confidence interval 0.05 to 0.60). Antipsychotic review plus social interaction significantly reduced mortality (odds ratio 0.36, 95% confidence interval 0.23 to 0.57), but this group showed significantly worse outcomes in behavioural and psychological symptoms of dementia than the group receiving neither antipsychotic review nor social interaction (mean difference 7.37 symptoms, 95% confidence interval 1.53 to 13.22 symptoms). This detrimental impact was reduced when combined with social interaction (mean difference –0.44 points, 95% confidence interval –4.39 to 3.52 points), but with no significant benefits for agitation. The exercise intervention significantly improved neuropsychiatric symptoms (mean difference –3.58 symptoms, 95% confidence interval –7.08 to –0.09 symptoms) but not depression (mean difference –1.21 points, 95% confidence interval –4.35 to 1.93 points). Qualitative work with care staff provided additional insights into the acceptability and feasibility of the intervention. Work package 4: optimisation of the WHELD programme led to a final version that combined person-centred care training with social interaction and pleasant activities. The intervention was adapted for delivery through a ‘champion’ model. Work package 5: a large-scale, multicentre randomised controlled trial in 69 care homes showed significant benefit to quality of life, agitation and overall neuropsychiatric symptoms, at reduced overall cost compared with treatment as usual. The intervention conferred a statistically significant improvement in quality of life (Dementia Quality of Life Scale – Proxy z-score of 2.82, mean difference 2.54, standard error of measurement 0.88, 95% confidence interval 0.81 to 4.28, Cohen’s d effect size of 0.24; p = 0.0042). There were also statistically significant benefits in agitation (Cohen-Mansfield Agitation Inventory z-score of 2.68, mean difference –4.27, standard error of measurement 1.59, 95% confidence interval –7.39 to –1.15, Cohen’s d effect size of 0.23; p = 0.0076) and overall neuropsychiatric symptoms (Neuropsychiatric Inventory – Nursing Home version z-score of 3.52, mean difference –4.55, standard error of measurement 1.28, 95% confidence interval –7.07 to –2.02, Cohen’s d of 0.30; p < 0.001). The WHELD programme contributed to significantly lower health and social care costs than treatment as usual (cost difference –£4740, 95% confidence interval –£6129 to –£3156). Focus groups were conducted with 47 staff up to 12 months after the end of work package 5, which demonstrated sustained benefits. Work package 6: the outputs of the programme were translated into general practitioner workshops and a British Medical Journal e-learning module, an updated national best practice guideline and a portfolio of lay and care home outreach activities.
Limitations
Residents with dementia were not involved in the qualitative work.
Conclusions
The WHELD programme is effective in improving quality of life and reducing both agitation and overall neuropsychiatric symptoms in people with dementia in care homes. It provides a structured training and support intervention for care staff, with lower overall costs for resident care than treatment as usual.
Future work
It will be important to consider the long-term sustainability of the WHELD programme and cost-effective means of long-term implementation.
Trial registration
Current Controlled Trials ISRCTN40313497 and ISRCTN62237498.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 8, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Clive Ballard
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Esme Moniz-Cook
- Faculty of Health and Social Care, Centre of Psychological Care and Ageing, University of Hull, Hull, UK
| | - Robert Woods
- Dementia Service Development Centre, Wales Dementias & Neurodegenerative Diseases Network, Bangor University, Bangor, UK
| | | | - Anne Corbett
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Dag Aarsland
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
- Centre for Age-related Medicine, Stavanger University Hospital, University of Stavanger, Stavanger, Norway
| | - Joanna Murray
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Vanessa Lawrence
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ingelin Testad
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Martin Knapp
- London School of Economics and Political Science, London, UK
| | - Renee Romeo
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Darshan Zala
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health & Social Care, Institute of Medical & Social Care Research, Bangor University, Bangor, UK
| | - Lucy Garrod
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Yongzhong Sun
- Dementia Service Development Centre, Wales Dementias & Neurodegenerative Diseases Network, Bangor University, Bangor, UK
| | | | | | - Gareth Williams
- Wolfson Centre for Age-Related Diseases, King’s College London, London, UK
| | - Jane Fossey
- Oxford Health NHS Foundation Trust, Oxford, UK
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Inker J, Jensen C, Barsness S, Stewart MM. Implementing Microlearning in Nursing Homes: Implications for Policy and Practice in Person-Centered Dementia Care. J Appl Gerontol 2020; 40:1062-1070. [PMID: 32525436 DOI: 10.1177/0733464820929832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to develop and pilot a 52-week Microlearning curriculum on person-centered dementia care in nine nursing homes. The goal was to evaluate the usability and application of Microlearning as a tool to increase staff knowledge and improve perceptions of people with dementia, thus increasing their ability to deliver person-centered care and their job satisfaction. Findings indicate that participants enjoyed the flexible, 24/7 access to training and found that the immediacy of the format encouraged them to apply their learning directly to practice. Staff knowledge and attitudes toward people with dementia were positively impacted by the training, as was job satisfaction. Further research to test the efficacy of Microlearning compared to usual training is warranted, as are coordinated policy development efforts that can guide the implementation of best practices in the use of Microlearning as an innovative training modality in nursing homes.
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Affiliation(s)
- Jenny Inker
- Virginia Commonwealth University, Richmond, USA
| | - Christine Jensen
- Riverside Center for Excellence in Aging and Lifelong Health, Williamsburg, VA, USA
| | | | - Mary Martha Stewart
- Riverside Center for Excellence in Aging and Lifelong Health, Williamsburg, VA, USA
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15
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Blake D, Berry K, Brown LJE. A systematic review of the impact of person-centred care interventions on the behaviour of staff working in dementia care. J Adv Nurs 2019; 76:426-444. [PMID: 31657034 DOI: 10.1111/jan.14251] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 08/20/2019] [Accepted: 10/22/2019] [Indexed: 11/29/2022]
Abstract
AIM To examine the content, focus, and effectiveness of person-centred care (PCC) interventions aimed at increasing staff PCC behaviour in health and social care settings for people with dementia. DESIGN Systematic search and narrative synthesis of quantitative data. DATA SOURCES PsychINFO, Medline, EMBASE, Web of knowledge, CINAHL, ASSIA, and BNI were searched from inception to 5 November 2016. REVIEW METHODS All records retrieved were screened using predetermined eligibility criteria. Quality assessment was performed with the Effective Public Health Practice Project tool (EPHPP). RESULTS A total of 4,367 records were screened and 33 studies examining the impact of PCC interventions were included. Eight different categories of PCC intervention were identified, with seven of these having at least some evidence to support their effectiveness in increasing staff PCC behaviour. CONCLUSION The range of interventions and outcome measures identified in this review highlight different ways PCC behaviour can be demonstrated by staff and the range of interventions that can be used to enhance PCC staff behaviour. In future, more rigorously controlled research comparing the relative effectiveness of these interventions will support nursing facilities and staff to choose appropriate interventions to support them in enhancing PCC. IMPACT This study addressed the health priority of increasing PCC for people with dementia. It found preliminary evidence that seven of the eight intervention types identified are effective at increasing staff PCC behaviour in health and social care settings for people with dementia.
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Affiliation(s)
- Daniel Blake
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Laura J E Brown
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
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16
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Page C, Howell D, Douglas N. Positive Culture Change in Long-Term Care: A Procedure to Enhance Speech-Language Pathologist–Certified Nursing Assistant Collaboration. ACTA ACUST UNITED AC 2019. [DOI: 10.1044/2019_pers-sig2-2019-0009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background
The majority of residents in long-term care (LTC) facilities have cognitive communication impairments impacting their ability to communicate basic wants and needs to caregivers, particularly certified nursing assistants (CNAs). Speech-language pathologists (SLPs) are the most qualified individuals to educate CNAs about residents' communication behaviors; however, there is limited literature that outlines specific, evidence-based procedures for CNAs and residents in the LTC environment. The purpose of this article is to describe such a procedure, including 2 case examples, within a framework of positive culture change.
Method
This clinical focus article aims to describe the details and benefits of providing professional support for CNAs during a communication plan intervention. Then, the article will discuss the association between professional support and positive culture change in LTC. Professional support involves valuing the experience and time CNAs spend with residents, consistently requesting feedback regarding trained communication strategies, educating, demonstrating, and problem-solving with CNAs, as well as acknowledging CNAs' use of communication strategies during daily care with residents.
Conclusions
SLPs can serve as trendsetters in establishing a positive, functional organizational culture in LTC by providing professional support to CNAs. This article outlined an evidence-based procedure designed for SLPs working in the LTC environment to contribute to such positive culture change.
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Affiliation(s)
- Christen Page
- Department of Educational Leadership, Counselor Education, and Communication Disorders, Eastern Kentucky University, Richmond
| | - Dana Howell
- Department of Occupational Sciences and Occupational Therapy, Eastern Kentucky University, Richmond
| | - Natalie Douglas
- Department of Speech-Language Pathology, Central Michigan University, Mount Pleasant
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17
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Keszycki RM, Fisher DW, Dong H. The Hyperactivity-Impulsivity-Irritiability-Disinhibition-Aggression-Agitation Domain in Alzheimer's Disease: Current Management and Future Directions. Front Pharmacol 2019; 10:1109. [PMID: 31611794 PMCID: PMC6777414 DOI: 10.3389/fphar.2019.01109] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/29/2019] [Indexed: 12/14/2022] Open
Abstract
Behavioral and psychological symptoms of dementia (BPSD) afflict the vast majority of patients with dementia, especially those with Alzheimer's disease (AD). In clinical settings, patients with BPSD most often do not present with just one symptom. Rather, clusters of symptoms commonly co-occur and can, thus, be grouped into behavioral domains that may ultimately be the result of disruptions in overarching neural circuits. One major BPSD domain routinely identified across patients with AD is the hyperactivity-impulsivity-irritiability-disinhibition-aggression-agitation (HIDA) domain. The HIDA domain represents one of the most difficult sets of symptoms to manage in AD and accounts for much of the burden for caregivers and hospital staff. Although many studies recommend non-pharmacological treatments for HIDA domain symptoms as first-line, they demonstrate little consensus as to what these treatments should be and are often difficult to implement clinically. Certain symptoms within the HIDA domain also do not respond adequately to these treatments, putting patients at risk and necessitating adjunct pharmacological intervention. In this review, we summarize the current literature regarding non-pharmacological and pharmacological interventions for the HIDA domain and provide suggestions for improving treatment. As epigenetic changes due to both aging and AD cause dysfunction in drug-targeted receptors, we propose that HIDA domain treatments could be enhanced by adjunct strategies that modify these epigenetic alterations and, thus, increase efficacy and reduce side effects. To improve the implementation of non-pharmacological approaches in clinical settings, we suggest that issues regarding inadequate resources and guidance for implementation should be addressed. Finally, we propose that increased monitoring of symptom and treatment progression via novel sensor technology and the "DICE" (describe, investigate, create, and evaluate) approach may enhance both pharmacological and non-pharmacological interventions for the HIDA domain.
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Affiliation(s)
- Rachel M. Keszycki
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Daniel W. Fisher
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA, United States
| | - Hongxin Dong
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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18
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Gitlin LN, Marx K, Scerpella D, Dabelko-Schoeny H, Anderson KA, Huang J, Pizzi L, Jutkowitz E, Roth DL, Gaugler JE. Embedding caregiver support in community-based services for older adults: A multi-site randomized trial to test the Adult Day Service Plus Program (ADS Plus). Contemp Clin Trials 2019; 83:97-108. [PMID: 31238172 PMCID: PMC7069225 DOI: 10.1016/j.cct.2019.06.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 06/07/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022]
Abstract
There are over five million people in the United States living with dementia. Most live at home and are cared for by family. These family caregivers often assume care responsibilities without education about the disease, skills training, or support, and in turn become at risk for depression, burden, and adverse health outcomes when compared to non-dementia caregivers. Despite over 200 caregiver interventions with proven benefits, many caregivers lack access to these programs. One approach to enhance access is to embed evidence-based caregiver support programs in existing community-based services for people with dementia such as adult day services (ADS). Here we describe the protocol for an embedded pragmatic trial designed to augment standard ADS known as ADS Plus. ADS Plus provides family caregivers with support via education, referrals, and problem-solving techniques over 12 months, and is delivered on-site by existing ADS staff. Embedding a program in ADS requires an understanding of outcomes and implementation processes in that specific context. Thus, we deploy a hybrid design involving a cluster randomized two-group trial to evaluate treatment effects on caregiver wellbeing, ADS utilization, as well as nursing home placement. We describe implementation practices in 30 to 50 geographically and racially/ethnically diverse participating sites. Clinical trial registration #: NCT02927821.
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Affiliation(s)
- Laura N Gitlin
- Drexel University, 1601 Cherry Street, 10th Floor, Room 1092, Philadelphia, PA 19102, United States of America.
| | - Katherine Marx
- Johns Hopkins School of Nursing, Center for Innovative Care in Aging, 901 N. Broadway, Room 214, Baltimore, MD 21205, United States of America.
| | - Daniel Scerpella
- Johns Hopkins School of Nursing, Center for Innovative Care in Aging, 901 North Broadway, 2nd Floor, Baltimore, MD 21205, United States of America.
| | - Holly Dabelko-Schoeny
- College of Social Work, 207 Stillman Hall, 1947 College Rd N., Columbus, OH 43210, United States of America.
| | - Keith A Anderson
- University of Montana, School of Social Work, 014 Jeannette Rankin Hall, 32 Campus Drive, Missoula, MT 59812-4392, United States of America.
| | - Jin Huang
- Johns Hopkins School of Medicine, Center on Aging and Health, 2024 East Monument Street, Baltimore, MD 21205, United States of America.
| | - Laura Pizzi
- University Ernest Mario School of Pharmacy, Center for Health Outcomes, Policy, and Economics, 160 Frelinghuysen Road - Suite 417, Piscataway, NJ 08854, United States of America.
| | - Eric Jutkowitz
- Brown University School of Public Health, Department of Health Services, Policy & Practice, BoxG-S121 (6), 121 S Main Street, Providence, RI 02912, United States of America.
| | - David L Roth
- Johns Hopkins School of Medicine, Center on Aging and Health, 2024 East Monument Street, Baltimore, MD 21205, United States of America.
| | - Joseph E Gaugler
- University of Minnesota, School of Nursing, 308 SE Harvard St, Minneapolis, MN 55455, United States of America.
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19
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Harwood RH, O’Brien R, Goldberg SE, Allwood R, Pilnick A, Beeke S, Thomson L, Murray M, Parry R, Kearney F, Baxendale B, Sartain K, Schneider J. A staff training intervention to improve communication between people living with dementia and health-care professionals in hospital: the VOICE mixed-methods development and evaluation study. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06410] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundTwenty-five per cent of hospital beds are occupied by a person living with dementia. Dementia affects expressive communication and understanding. Health-care professionals report a lack of communication skills training.ObjectivesTo identify teachable, effective strategies for communication between health-care professionals and people living with dementia, and to develop and evaluate a communication skills training course.DesignWe undertook a systematic literature review, video-recorded 41 encounters between staff and people with dementia, and used conversation analysis to investigate communication problems and solutions. We designed a communication skills training course using coproduction and multiple pedagogic approaches. We ran a pilot, followed by six courses for health-care professionals. We measured knowledge, confidence and communication behaviours before, immediately after and 1 month after the course, and undertook interviews with participants and managers. Behaviours were measured using blind-rated videos of simulations.SettingGeneral hospital acute geriatric medical wards and two hospital clinical skills centres.ParticipantsWe video-recorded 26 people with dementia and 26 professionals. Ten experts in dementia care, education, simulation and communication contributed to intervention development. Six health-care professionals took part in a pilot course, and 45 took part in the training.ResultsThe literature review identified 26 studies describing 10 communication strategies, with modest evidence of effectiveness. Health-care professional-initiated encounters followed a predictable phase structure. Problems were apparent in requests (with frequent refusals) and in closings. Success was more likely when requests were made directly, with high entitlement (authority to ask) and with lowered contingencies (made to sound less difficult, by minimising the extent or duration of the task, asking patients ‘to try’, offering help or proposing collaborative action). Closings were more successful if the health-care professional announced the end of the task, made a specific arrangement, body language matched talk, and through use of ‘closing idioms’. The training course comprised 2 days, 1 month apart, using experiential learning, including lectures, video workshops, small group discussions, simulations (with specially trained actors) and reflections. We emphasised the incorporation of previous expertise and commitment to person-centred care. Forty-four participants returned for the second training day and 43 provided complete evaluation data. Knowledge and confidence both increased. Some behaviours, especially relating to closings, were more commonly used after training. The course was rated highly in interviews, especially the use of simulations, real-life video clips and interdisciplinary learning. Participants reported that they found the methods useful in practice and were using them 1 month after the course finished.LimitationsData were from people with moderate to severe dementia, in an acute hospital, during health-care professional-initiated interactions. Analysis was limited to problems and solutions that were likely to be ‘trainable’. Actors required careful preparation to simulate people with dementia. Communication skills training course participants were volunteers, unlikely to be representative of the general workforce, who displayed high levels of baseline knowledge, confidence and skills. Before-and-after evaluations, and qualitative interviews, are prone to bias.ConclusionsRequests and closings pose particular difficulties for professionals communicating with people with dementia. We identified solutions to these problems and incorporated them into communication skills training, which improved knowledge, confidence and some communication behaviours. Simulation was an effective training modality.Future workFurther research should investigate a wider range of health, social care and family carers. Conversation analysis should be used to investigate other aspects of health-care communication.Study registrationThe systematic literature review is registered as CRD42015023437.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Rowan H Harwood
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Rebecca O’Brien
- School of Health Sciences, University of Nottingham, Nottingham, UK
- CityCare Partnership CIC, Nottingham, UK
| | - Sarah E Goldberg
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Rebecca Allwood
- School of Health Sciences, University of Nottingham, Nottingham, UK
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Alison Pilnick
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Suzanne Beeke
- Language and Cognition Research, University College London, London, UK
| | - Louise Thomson
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Megan Murray
- Trent Simulation and Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ruth Parry
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Fiona Kearney
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Bryn Baxendale
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- Trent Simulation and Clinical Skills Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kate Sartain
- Patient and Public Contributor, Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Justine Schneider
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
- Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
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20
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Nguyen H, Terry D, Phan H, Vickers J, McInerney F. Communication training and its effects on carer and care-receiver outcomes in dementia settings: A systematic review. J Clin Nurs 2018; 28:1050-1069. [DOI: 10.1111/jocn.14697] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 09/16/2018] [Accepted: 10/18/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Hoang Nguyen
- Wicking Dementia Research and Education Centre; College of Health and Medicine; University of Tasmania; Hobart Tasmania Australia
| | - Daniel Terry
- Faculty of Health; Federation University; Ballarat Victoria Australia
| | - Hoang Phan
- Menzies Institute for Medical Research; College of Health and Medicine; University of Tasmania; Hobart Tasmania Australia
| | - James Vickers
- Wicking Dementia Research and Education Centre; College of Health and Medicine; University of Tasmania; Hobart Tasmania Australia
| | - Fran McInerney
- Wicking Dementia Research and Education Centre; College of Health and Medicine; University of Tasmania; Hobart Tasmania Australia
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21
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An Interprofessional Communication Training Program to Improve Nurses’ Ability to Communicate With Stroke Patients With Communication Disorders. Rehabil Nurs 2018; 43:E25-E34. [DOI: 10.1097/rnj.0000000000000041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Bauer M, Fetherstonhaugh D, Haesler E, Beattie E, Hill KD, Poulos CJ. The impact of nurse and care staff education on the functional ability and quality of life of people living with dementia in aged care: A systematic review. NURSE EDUCATION TODAY 2018; 67:27-45. [PMID: 29729501 DOI: 10.1016/j.nedt.2018.04.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/27/2018] [Accepted: 04/13/2018] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Educational initiatives can improve care delivery and the experience of living in residential aged care for people with dementia. This review aimed to determine the impact of nurse and care staff education on measures of functional ability and quality of life for older people with dementia living in care homes. DESIGN Systematic review. DATA SOURCES Search of on-line databases in English between January 2000 and January 2017. REVIEW METHODS Three reviewers used data extraction and critical appraisal tools of the Joanna Briggs Institute to determine methodological quality of research. RESULTS AND CONCLUSION Thirty-two studies met the initial inclusion criteria and 13 were retrieved for full appraisal. There was limited impact of nurse and care staff education on residents' agitation, anxiety, mood and quality of life. The most consistent improvement in functional ability due to education may be in the execution of activities of daily living. More successful programs included multi-faceted components (e.g. hands on support, clinical auditing) in conjunction with didactic teaching. There is a need for more rigorous and well-designed studies to test interventions.
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Affiliation(s)
- Michael Bauer
- Australian Centre for Evidence Based Aged Care, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.
| | - Deirdre Fetherstonhaugh
- Australian Centre for Evidence Based Aged Care, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.
| | - Emily Haesler
- Australian Centre for Evidence Based Aged Care, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Elizabeth Beattie
- School of Nursing and Midwifery, Faculty of Health, Queensland University of Technology, Queensland, Australia.
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Western Australia, Australia.
| | - Christopher J Poulos
- Research and Aged Care Clinical Services, Centre for Positive Ageing, Hammond Care, New South Wales, Australia.
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23
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Piau A, Nourhashemi F, De Mauléon A, Tchalla A, Vautier C, Vellas B, Duboue M, Costa N, Rumeau P, Lepage B, Soto Martin M. Telemedicine for the management of neuropsychiatric symptoms in long-term care facilities: the DETECT study, methods of a cluster randomised controlled trial to assess feasibility. BMJ Open 2018; 8:e020982. [PMID: 29895651 PMCID: PMC6009473 DOI: 10.1136/bmjopen-2017-020982] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Neuropsychiatric symptoms (NPSs) in elderly patients with dementia are frequent in long-term care facilities (LTCFs) and are associated with adverse events. Telemedicine is an emerging way to provide consultation and care to dependent LTCF residents who may not have easy access to specialty services. Several studies have evaluated telemedicine for dementia care but to date, no study has evaluated its impact in the management of NPS in patients with dementia living in LTCF. METHODS AND ANALYSIS The Dementia in long-term care facilities: Telemedicine for the management of neuropsychiatric symptoms (DETECT) study is a 24-month multicentre prospective cluster randomised controlled study with two arms: a control arm (usual care) and an intervention arm (telemedicine consultation) for NPSs management. DETECT enrolled 20 LTCFs. The primary outcome is based on the acceptability of the telemedicine among the LTCF staff which will be assessed in the intervention group by quantitative and qualitative indicators. The rate of unscheduled hospitalisations and/or consultations due to disruptive NPSs, psychotropic drug use and health costs will be described in both groups. Approximately, 200 patients are expected to be recruited. ETHICS AND DISSEMINATION The study protocol was approved and sponsored by the French Ministry of Health. The study received ethical approval from the Toulouse University Hospital Institutional Review Board. We will communicate the final results to the public via conferences and results will also be submitted for publication in international peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT02472015.
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Affiliation(s)
| | - Fati Nourhashemi
- Gérontopôle, CHU Toulouse, Toulouse, France
- UMR 1027, INSERM, Toulouse, France
| | | | | | - Claude Vautier
- Manufacture des Tabacs, Université des Sciences Sociales-Toulouse 1, Toulouse, France
| | - Bruno Vellas
- Gérontopôle, CHU Toulouse, Toulouse, France
- UMR 1027, INSERM, Toulouse, France
| | | | - Nadège Costa
- Medical Information Department, CHU Toulouse, Toulouse, France
| | | | - Benoit Lepage
- Department of Epidemiology, CHU Toulouse, USMR, Toulouse, France
| | - Maria Soto Martin
- Gérontopôle, CHU Toulouse, Toulouse, France
- UMR 1027, INSERM, Toulouse, France
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Organizational and environmental factors associated with transfers of nursing home residents to emergency departments. Eur Geriatr Med 2018; 9:339-346. [PMID: 34654246 DOI: 10.1007/s41999-018-0059-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/30/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND/OBJECTIVES The emergency department transfer (EDT) rate of residents from nursing homes (NHs) to emergency departments is an important public health issue. The purpose of this study was to examine whether organizational and geographical factors were associated with EDT among older adults living in NHs. DESIGN Retrospective analysis using information from patients' medical charts regarding hospitalization in the last 12 months. Information came from the baseline data of the IQUARE clinical trial. PARTICIPANTS 5926 residents (86.0 years old, standard deviation, SD = 2.9), from 175 NHs with available data on EDT. OUTCOME MEASURE The EDT rate was estimated for each NH, from the number of residents who were transferred to an emergency department (one transfer or more) in the previous 12 months. RESULTS 1119 (18.9%, SD = 11.5) residents were transferred to an emergency department at least once during the past year. In adjusted multiple linear regression, NHs located in rural areas had an EDT rate significantly lower than those in urban areas (confidence interval, 95% CI - 10.15, - 2.16, p = 0.003), with an absolute EDT rate of 16.4% (SD = 9.1) versus 20.4% (SD = 12.5); pharmacy for internal use was significantly associated with a lower EDT rate compared with the NHs with no PUI [11.9% (SD = 9.2); 19.1% (SD = 10.1), 95% CI - 16.33, - 3.09, p = 0.004] and the implementation of a personalized care project in NHs was significantly associated with a lower EDT rate [18.6% (SD = 11.4), 22.4% (SD = 12.4), 95% CI - 11.67, - 0.63, p = 0.03]. CONCLUSION Our study suggests that a structured plan of care, a strategy to improve medication and being located in rural areas reduce the EDT rate in NH residents. IQUARE STUDY TRIAL REGISTRATION NUMBER NCT01703689.
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Tsai PF, Kitch S, Beck C, Jakobs T, Rettiganti M, Jordan K, Jakobs E, Adair S. Using an Interactive Video Simulator to Improve Certified Nursing Assistants' Dressing Assistance and Nursing Home Residents' Dressing Performance: A Pilot Study. Comput Inform Nurs 2018; 36:183-192. [PMID: 29406394 PMCID: PMC6034624 DOI: 10.1097/cin.0000000000000415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This pilot study examined the initial effects and estimated effect size of a computer-based simulation education program on certified nursing assistants' level of assistance when dressing nursing home residents with dementia and on residents' dressing performance. Nine dyads, assigned to either the experimental or control group, completed the study. Both groups received a traditional 1-hour education module delivered by a research assistant. The experimental group was then instructed to undertake an additional 2-hour intervention using a video simulator that enabled nursing assistants to practice level of assistance skills. The appropriateness of dressing assistance from nursing assistants and residents' dressing performance was measured before and 6 weeks after the intervention. The results showed that the two groups did not significantly differ in either appropriate levels of dressing assistance (P = .42) or residents' dressing performance (P = .38). A lack of effort by some assistants to properly assist residents and low statistical power may explain the lack of significance. The effect sizes of the experimental intervention on appropriate levels of dressing assistance and resident dressing performance were 0.69 and 0.89, respectively. Incorporating a strategy to improve motivation should be considered in future studies.
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Affiliation(s)
- Pao-Feng Tsai
- Author Affiliations: College of Nursing (Drs Tsai and Kitch) and Department of Geriatrics, College of Medicine (Dr Beck), University of Arkansas for Medical Sciences, Little Rock; InvoTek, Inc, Alma (Mr T. Jakobs, Mr E. Jakobs, and Mr Adair); Biostatistics Program, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock (Dr Rettiganti); and Department of Nursing, University of Central Arkansas, Conway (Dr Jordan), AR
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Dobbs D, Hobday J, Roker R, Kaas MJ, Molinari V. Certified nursing assistants' perspectives of the CARES® activities of daily living dementia care program. Appl Nurs Res 2018; 39:244-248. [DOI: 10.1016/j.apnr.2017.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 11/01/2017] [Accepted: 11/02/2017] [Indexed: 11/26/2022]
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Gilster SD, Boltz M, Dalessandro JL. Long-Term Care Workforce Issues: Practice Principles for Quality Dementia Care. THE GERONTOLOGIST 2018; 58:S103-S113. [DOI: 10.1093/geront/gnx174] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Indexed: 11/14/2022] Open
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Gerolimatos LA, Page KS, Balestracci P, Hinrichs KLM. Interdisciplinary development and implementation of a dementia skills training program in a VA community living center: a pilot study. Geriatr Nurs 2018; 39:400-406. [PMID: 29336830 DOI: 10.1016/j.gerinurse.2017.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 12/05/2017] [Accepted: 12/11/2017] [Indexed: 12/29/2022]
Abstract
This pilot study investigates the usefulness of a dementia care training program developed by an interdisciplinary team to address problem behaviors associated with dementia. Staff members of a VA Community Living Center completed an 8-hour workshop covering fundamental knowledge about dementia and instruction in skills to use with patients through video, lecture, and role-plays. Measures on dementia knowledge and perceived self-efficacy were completed by staff members before and after the workshop. Results revealed increases in self-efficacy and knowledge, with particular gains in general knowledge of dementia and communicating with patients. Younger staff members scored higher on tests of knowledge at pre- and post-test, whereas staff members with more years of work experience rated their self-efficacy higher at post-test only. There was an associated decrease in assaultive behaviors by patients with dementia in the year this workshop was implemented. Results highlight the benefit of interdisciplinary collaboration in developing educational content and the value of providing staff training on managing dementia-related behaviors. Adjustments to this training program are discussed.
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Affiliation(s)
| | - Kyle S Page
- VA Central Iowa Healthcare System, Des Moines, IA
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Molinari V, Hobday JV, Roker R, Kunik ME, Kane R, Kaas MJ, Mehrotra C, Williams CL, Robbins JC, Dobbs D. Impact of serious mental illness online training for certified nursing assistants in long term care. GERONTOLOGY & GERIATRICS EDUCATION 2017; 38:359-374. [PMID: 28632071 PMCID: PMC6192676 DOI: 10.1080/02701960.2016.1188811] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Certified nurse assistants (CNAs) spend the most staff time with nursing home residents, yet they receive little training in addressing the mental health needs of residents with serious mental illness (SMI). Forty CNAs from four long-term-care facilities took the online interactive CARES-® Serious Mental Illness™ training consisting of two modules guided by the Recovery Movement philosophy of care. Responses from pre-post testing, Likert-type items, and open-ended questions indicated that CNAs gained information, changed their perspectives, and had more confidence in dealing with SMI. Although there were minor concerns regarding length, clarity of content, and technical issues, CNAs found the online format acceptable and easy to use, and many said they would recommend the training. CARES Serious Mental Illness online training appears to be a viable way of helping CNAs address the mental health needs of long term care residents. Additional testing on CARES Serious Mental Illness is planned.
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Affiliation(s)
- Victor Molinari
- a University of South Florida , School of Aging Studies , Tampa , Florida USA
| | - John V Hobday
- b HealthCare Interactive, Inc. , Minneapolis , Minnesota USA
| | - Rosalyn Roker
- a University of South Florida , School of Aging Studies , Tampa , Florida USA
| | - Mark E Kunik
- c Michael E. DeBakey VA Medical Center, Houston, Texas USA and Baylor College of Medicine , Houston , Texas USA
| | - Rosalie Kane
- d University of Minnesota , Center on Aging , Minneapolis , Minnesota USA
| | - Merrie J Kaas
- e University of Minnesota , School of Nursing , Minneapolis , Minnesota USA
| | | | | | - Joyce C Robbins
- h HealthCare Interactive, Inc. , Minneapolis , Minnesota USA
| | - Debra Dobbs
- i University of South Florida , Tampa , Florida USA
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Effects of the Advanced Innovative Internet-Based Communication Education Program on Promoting Communication Between Nurses and Patients With Dementia. J Nurs Res 2017; 24:163-72. [PMID: 26376065 DOI: 10.1097/jnr.0000000000000109] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Effective communication between nurses and patients with dementia promotes the quality of patient care by improving the identification of patient needs and by reducing the miscommunication-related frustration of patients and nurses. PURPOSE This study evaluates the effects of an advanced innovative Internet-based communication education (AIICE) program on nurses' communication knowledge, attitudes, frequency of assessing patient communication capacity, and communication performance in the context of care for patients with dementia. In addition, this study attempts to evaluate the indirect effects of this program on outcomes for patients with dementia, including memory and behavior-related problems and depressive symptoms. METHODS A quasi-experimental research design with a one-group repeated measure was conducted. Convenience sampling was used to recruit nurses from long-term care facilities in southern Taiwan. Data were analyzed using general estimating equations to compare changes over time across three points: baseline, fourth-week posttest, and 16th-week posttest. One hundred five nurses completed the AIICE program and the posttest surveys. RESULTS The findings indicate that nurses' communication knowledge, frequency in assessing patients' communication capacity, and communication performance had improved significantly over the baseline by either the 4th- or 16th-week posttest (p < .01). However, communication attitude showed no significant improvement in the posttest survey (p = .40). Furthermore, the findings indicate that the memory and behavior-related problems and the depressive symptoms of patients had decreased significantly by the 16th-week posttest (p = .05). CONCLUSIONS/IMPLICATIONS FOR PRACTICE This study showed that the AIICE program improves nurses' communication knowledge, frequency to assess patients' communication capacity, and communication performance and alleviates the memory and behavior-related problems and depressive symptoms of patients. The continuous communication training of nurses using the AIICE program is thus recommended.
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Kemeny ME, Mabry JB. Making meaningful improvements to direct care worker training through informed policy: Understanding how care setting structure and culture matter. GERONTOLOGY & GERIATRICS EDUCATION 2017; 38:295-312. [PMID: 26453054 DOI: 10.1080/02701960.2015.1103652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Well-intentioned policy governing the training of direct care workers (DCWs) who serve older persons, in practice, may become merely a compliance issue for organizations rather than a meaningful way to improve quality of care. This study investigates the relationships between best practices in DCW training and the structure and culture of long term support service (LTSS) organizations. Using a mixed-methods approach to analyzing data from 328 licensed LTSS organizations in Pennsylvania, the findings suggest that public policy should address methods of training, not just content, and consider organizational variations in size, training evaluation practices, DCW integration, and DCW input into care planning. Effective training also incorporates support for organizations and supervisors as key aspects of DCWs' learning and working environment.
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Affiliation(s)
- M Elizabeth Kemeny
- a College of Health, Environment, and Science , Slippery Rock University , Slippery Rock , Pennsylvania , USA
| | - J Beth Mabry
- b Department of Sociology , Indiana University of Pennsylvania , Indiana , Pennsylvania , USA
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Hoben M, Kent A, Kobagi N, Huynh KT, Clarke A, Yoon MN. Effective strategies to motivate nursing home residents in oral care and to prevent or reduce responsive behaviors to oral care: A systematic review. PLoS One 2017; 12:e0178913. [PMID: 28609476 PMCID: PMC5469468 DOI: 10.1371/journal.pone.0178913] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/09/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Poor oral health has been a persistent problem in nursing home residents for decades, with severe consequences for residents and the health care system. Two major barriers to providing appropriate oral care are residents' responsive behaviors to oral care and residents' lack of ability or motivation to perform oral care on their own. OBJECTIVES To evaluate the effectiveness of strategies that nursing home care providers can apply to either prevent/overcome residents' responsive behaviors to oral care, or enable/motivate residents to perform their own oral care. MATERIALS AND METHODS We searched the databases Medline, EMBASE, Evidence Based Reviews-Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science for intervention studies assessing the effectiveness of eligible strategies. Two reviewers independently (a) screened titles, abstracts and retrieved full-texts; (b) searched key journal contents, key author publications, and reference lists of all included studies; and (c) assessed methodological quality of included studies. Discrepancies at any stage were resolved by consensus. We conducted a narrative synthesis of study results. RESULTS We included three one-group pre-test, post-test studies, and one cross-sectional study. Methodological quality was low (n = 3) and low moderate (n = 1). Two studies assessed strategies to enable/motivate nursing home residents to perform their own oral care, and to studies assessed strategies to prevent or overcome responsive behaviors to oral care. All studies reported improvements of at least some of the outcomes measured, but interpretation is limited due to methodological problems. CONCLUSIONS Potentially promising strategies are available that nursing home care providers can apply to prevent/overcome residents' responsive behaviors to oral care or to enable/motivate residents to perform their own oral care. However, studies assessing these strategies have a high risk for bias. To overcome oral health problems in nursing homes, care providers will need practical strategies whose effectiveness was assessed in robust studies.
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Affiliation(s)
- Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Angelle Kent
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Nadia Kobagi
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kha Tu Huynh
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Alix Clarke
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Minn N. Yoon
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Abraha I, Rimland JM, Trotta FM, Dell'Aquila G, Cruz-Jentoft A, Petrovic M, Gudmundsson A, Soiza R, O'Mahony D, Guaita A, Cherubini A. Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series. BMJ Open 2017; 7:e012759. [PMID: 28302633 PMCID: PMC5372076 DOI: 10.1136/bmjopen-2016-012759] [Citation(s) in RCA: 252] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 09/05/2016] [Accepted: 10/04/2016] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To provide an overview of non-pharmacological interventions for behavioural and psychological symptoms in dementia (BPSD). DESIGN Systematic overview of reviews. DATA SOURCES PubMed, EMBASE, Cochrane Database of Systematic Reviews, CINAHL and PsycINFO (2009-March 2015). ELIGIBILITY CRITERIA Systematic reviews (SRs) that included at least one comparative study evaluating any non-pharmacological intervention, to treat BPSD. DATA EXTRACTION Eligible studies were selected and data extracted independently by 2 reviewers.The AMSTAR checklist was used to assess the quality of the SRs. DATA ANALYSIS Extracted data were synthesised using a narrative approach. RESULTS 38 SRs and 129 primary studies were identified, comprising the following categories of non-pharmacological interventions: (1) sensory stimulation interventions (25 SRs, 66 primary studies) that encompassed: shiatsu and acupressure, aromatherapy, massage/touch therapy, light therapy, sensory garden and horticultural activities, music/dance therapy, dance therapy, snoezelen multisensory stimulation therapy, transcutaneous electrical nerve stimulation; (2) cognitive/emotion-oriented interventions (13 SRs; 26 primary studies) that included cognitive stimulation, reminiscence therapy, validation therapy, simulated presence therapy; (3) behaviour management techniques (6 SRs; 22 primary studies); (4) Multicomponent interventions (3 SR; four primary studies); (5) other therapies (5 SRs, 15 primary studies) comprising exercise therapy, animal-assisted therapy, special care unit and dining room environment-based interventions. CONCLUSIONS A large number of non-pharmacological interventions for BPSD were identified. The majority of the studies had great variation in how the same type of intervention was defined and applied, the follow-up duration, the type of outcome measured, usually with modest sample size. Overall, music therapy and behavioural management techniques were effective for reducing BPSD.
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Affiliation(s)
- Iosief Abraha
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - Joseph M Rimland
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - Fabiana Mirella Trotta
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - Giuseppina Dell'Aquila
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | | | - Mirko Petrovic
- Department of Internal Medicine (Geriatrics), Ghent University,Ghent, Belgium
| | | | - Roy Soiza
- Department of Medicine for the Elderly, Woodend Hospital, Aberdeen, UK
| | - Denis O'Mahony
- Department of Medicine, University College Cork, Cork, Ireland
| | | | - Antonio Cherubini
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
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García-Alberca JM. Cognitive-behavioral treatment for depressed patients with Alzheimer's disease. An open trial. Arch Gerontol Geriatr 2017; 71:1-8. [PMID: 28237746 DOI: 10.1016/j.archger.2017.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 02/05/2017] [Accepted: 02/07/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Depression has a high prevalence among patients with Alzheimer's disease, and it has a significant negative impact on their functioning. However, despite its significant impact and challenge, few treatment outcomes data are available to guide clinical care of depression among this population. We developed a cognitive-behavioral intervention to persons with AD. In this paper, we describe the intervention and results of an open trial evaluating its feasibility and utility. SETTING Dementia Unit. SUBJECT Alzheimer's disease patients. METHODS The treatment was administered over a period of three months with the implication of a caregiver. Dyads were followed for an additional three months in-person sessions. A selection of skills is offered, including education and self-awareness, coping self-statements, behavioral activation, problem-solving therapy, exercise, and caregiver education. RESULTS Nine participants were enrolled. Overall, patients and caregivers were satisfied with the treatment and reported that they benefited-in terms of depression, anxiety, and caregiver distress. CONCLUSIONS These findings are preliminaries and attention now needs to be turned to futher evaluation in a randomized clinical trial.
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Kim SK, Park M. Effectiveness of person-centered care on people with dementia: a systematic review and meta-analysis. Clin Interv Aging 2017; 12:381-397. [PMID: 28255234 PMCID: PMC5322939 DOI: 10.2147/cia.s117637] [Citation(s) in RCA: 217] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Person-centered care is a holistic and integrative approach designed to maintain well-being and quality of life for people with dementia, and it includes the elements of care, the individual, the carers, and the family. Aim A systematic literature review and meta-analysis were undertaken to investigate the effectiveness of person-centered care for people with dementia. Methods Literature searches were undertaken using six databases including Medline, EMBASE, CINAHL, PsycINFO, Cochrane Database, and KoreaMed using the following keywords: cognition disorder, dementia, person-centered care, patient-centered care, client-centered care, relationship-centered care, and dementia care. The searches were limited to interventional studies written in English and Korean and included randomized controlled studies and noncontrolled studies for people with dementia living in any setting. Results Nineteen interventional studies, including 3,985 participants, were identified. Of these, 17 studies were from long-term care facilities and two studies were from homecare settings. The pooled data from randomized controlled studies favored person-centered care in reducing agitation, neuropsychiatric symptoms, and depression and improving the quality of life. Subgroup analysis identified greater effectiveness of person-centered care when implemented for people with less severe dementia. For agitation, short-term interventions had a greater effect (standardized mean difference [SMD]: −0.434; 95% conference interval [CI]: −0.701 to −0.166) than long-term interventions (SMD: −0.098; 95% CI: −0.190 to 0.007). Individualized activities resulted in a significantly greater beneficial effect than standard care (SMD: 0.513; 95% CI: −0.994 to −0.032). However, long-term, staff education, and cultural change interventions had a greater effect on improving the quality of life for people with dementia (SMD: 0.191; 95% CI: 0.079 to 0.302). Conclusion This systematic review and meta-analysis provided evidence for person-centered care in clinical practice for people with dementia. Person-centered care interventions were shown to reduce agitation, neuropsychiatric symptoms, and depression and to improve the quality of life. Person-centered care interventions can effectively reduce agitation for a short term using intensive and activity-based intervention. However, an educational strategy that promotes learning and skill development of internal care staff is needed to enhance patient’s quality of life and to ensure the sustainability of the effects of behavioral problems. The feasibility and effectiveness of the intervention, the severity of patient disease, and intervention type and duration should be considered as part of an intervention design.
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Affiliation(s)
- Sun Kyung Kim
- Education and Research Center for Evidence Based Nursing Knowledge, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Myonghwa Park
- Education and Research Center for Evidence Based Nursing Knowledge, College of Nursing, Chungnam National University, Daejeon, Republic of Korea
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Rapaport P, Livingston G, Murray J, Mulla A, Cooper C. Systematic review of the effective components of psychosocial interventions delivered by care home staff to people with dementia. BMJ Open 2017; 7:e014177. [PMID: 28183810 PMCID: PMC5306506 DOI: 10.1136/bmjopen-2016-014177] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This review aims to understand what elements of psychosocial interventions are associated with improved outcomes for people with dementia to inform implementation in care homes. DESIGN A systematic review of qualitative and quantitative intervention studies was undertaken. ELIGIBILITY CRITERIA FOR INCLUDED STUDIES We included primary research studies evaluating psychosocial interventions that trained care home staff to deliver a specific intervention or that sought to change how staff delivered care to residents with dementia and reported staff and resident qualitative or quantitative outcomes. METHODS We searched MEDLINE, PsychINFO and EMBASE electronic databases and hand-searched references up to May 2016. Quality of included papers was rated independently by 2 authors, using operationalised checklists derived from standard criteria. We discussed discrepancies and reached consensus. We conducted a narrative synthesis of quantitative and a thematic synthesis of qualitative findings to find what was effective immediately and in sustaining change. RESULTS We identified 49 papers fulfilling predetermined criteria. We found a lack of higher quality quantitative evidence that effects could be sustained after psychosocial interventions finished with no evidence that interventions continued to work after 6 months. Qualitative findings suggest that staff valued interventions focusing on getting to know, understand and connect with residents with dementia. Successful elements of interventions included interactive training, post-training support, aiming to train most staff, retaining written materials afterwards and building interventions into routine care. CONCLUSIONS Psychosocial interventions can improve outcomes for staff and residents with dementia in care homes; however, many trial results are limited. Synthesis of qualitative findings highlight core components of interventions that staff value and feel improve care. These findings provide useful evidence to inform the development of sustainable, effective psychosocial interventions in care homes. TRIAL REGISTRATION NUMBER CRD42015017621.
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Affiliation(s)
- Penny Rapaport
- Division of Psychiatry, University College London, London, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
| | - Joanna Murray
- Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK
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Bird M, Anderson K, MacPherson S, Blair A. Do interventions with staff in long-term residential facilities improve quality of care or quality for life people with dementia? A systematic review of the evidence. Int Psychogeriatr 2016; 28:1937-1963. [PMID: 27439660 DOI: 10.1017/s1041610216001083] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Common sense suggests and research indicates relationships between staff factors in residential dementia care and quality of life (QOL) for residents, with poor care increasing suffering. However, we do not have a coherent picture of which staff interventions have an impact on quality of care (QOC) or resident QOL. METHODS A comprehensive search of 20 years' peer-reviewed literature using Medline, PsycINFO, Embase, PubMed, CINAHL, and the Cochrane, Campbell Collaboration identified 4,760 studies meriting full text review. Forty-six met the inclusion criteria, namely interventions in long-term facilities helping staff develop their capacity to provide better care and/or QOL for residents with dementia. Thirty-five other papers comprised an associated predictor review. RESULTS Conclusions from these limited data are further compromised because nine studies failed to measure effects on residents and only half assessed effects after the project team withdrew. Of these, excellent studies produced change over the medium (3-4 months) or longer term, including reduction in challenging behavior and restraint use but this applied only to a minority. A number of studies failed to measure effects on QOC, limiting conclusions about mechanisms underlying change. CONCLUSION In general, level of intervention required depended on the target. For outcomes like restraint use, structured education sessions with some support appear adequate. Programs to reduce pain require more support. For complicated issues like challenging behavior and increasing co-operation in showering, detailed, supportive, on-site interventions are required. Improvements in restraint and staff/resident interactions were the most promising findings. (Review registration number: PROSPERO 2014:CRD42014015224).
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Affiliation(s)
- Mike Bird
- Dementia Services Development Centre,Bangor University,Bangor,Gwynedd,UK
| | - Katrina Anderson
- NHMRC Cognitive Decline Partnership Centre,Sydney,New South Wales,Australia
| | - Sarah MacPherson
- NHMRC Cognitive Decline Partnership Centre,Sydney,New South Wales,Australia
| | - Annaliese Blair
- NHMRC Cognitive Decline Partnership Centre,Sydney,New South Wales,Australia
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Abstract
Over the past three decades, there has been a notable increase in studies of practice change interventions in long-term care (LTC) settings. This review, based on a modified realist approach, addresses the following questions: What practice change intervention characteristics work? And, in what circumstances do they work and why? A modified realist approach was applied to identify and explain the interactions among context, mechanism, and outcome. We searched electronic databases and published literature for empirical studies of practice change interventions that (a) were conducted in LTC settings, (b) involved formal care staff members, and (c) reported a formal evaluation. Ninety-four articles met the inclusion criteria. Interventions that included only predisposing factors were least likely to be effective. Interventions that included reinforcing factors were most likely to produce sustained outcomes. We concluded that interventions aimed at practice change in LTC settings should include feasible and effective enabling and reinforcing factors.
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Stanyon MR, Griffiths A, Thomas SA, Gordon AL. The facilitators of communication with people with dementia in a care setting: an interview study with healthcare workers. Age Ageing 2016; 45:164-70. [PMID: 26764403 PMCID: PMC4711655 DOI: 10.1093/ageing/afv161] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives: to describe the views of healthcare workers on the facilitators of communication with people with dementia in a care setting. Design: thematic analysis of semi-structured interviews. Setting: all participants were interviewed in their place of work. Participants: sixteen healthcare workers whose daily work involves interacting with people with dementia. Results: four overarching categories of themes were identified from the interviews that impact on communication: the attributes of a care worker, communication strategies used, organisational factors and the physical characteristics of the care environment. Conclusion: many strategies used by healthcare workers to facilitate communication have not yet been studied in the research literature. Participants' views on training should be incorporated into future dementia training programmes.
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Affiliation(s)
- Miriam Ruth Stanyon
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Amanda Griffiths
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Shirley A Thomas
- Division of Rehabilitation and Ageing, University of Nottingham, Medical School Queens Medical Centre, Nottingham NG7 2UH, UK
| | - Adam Lee Gordon
- Division of Rehabilitation and Ageing, University of Nottingham, Medical School Queens Medical Centre, Nottingham NG7 2UH, UK
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Thunborg C, Heideken Wågert PV, Ivarsson AB, Söderlund A. Inter- and Intra-Rater Reliability of a Newly Developed Assessment Scale: The Dyadic Interaction in Dementia Transfer Assessment Scale (DIDTAS). PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2015. [DOI: 10.3109/02703181.2015.1065939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ellis ML, Molinari V, Dobbs D, Smith K, Hyer K. Assessing approaches and barriers to reduce antipsychotic drug use in Florida nursing homes. Aging Ment Health 2015; 19:507-16. [PMID: 25166458 DOI: 10.1080/13607863.2014.952710] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Antipsychotic medications have been federally regulated since 1987, yet research suggests they continue to be used inappropriately to alleviate behavioral symptoms associated with dementia. In 2012, the Centers of Medicare and Medicaid launched a new initiative to reduce antipsychotic medication in nursing homes by 15% nationally. The aim of this study was to examine qualitative data to explore strategies that have been implemented, to assess which strategies are evidence-based, and to make recommendations to improve upon practices to reduce antipsychotic medication use. METHOD A convenience sample of 276 nursing home professional staff members were surveyed about these topics using open-ended questions. RESULTS Theme-based content analysis yielded three main themes. The themes related to changes in practice included the following: (1) increased review of resident behavior and antipsychotic medication regimens; (2) reduction in antipsychotic medications or dosage; and (3) increased use of nonpharmacological interventions. The main themes relevant to needed assistance included the following: (1) education; (2) clinical support; and (3) increased financial resources and reimbursement. DISCUSSION Overall findings indicate that the majority of facilities are actively responding to the initiative, but challenges remain in education, finding mental health support, and in reimbursement.
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Affiliation(s)
- Michelle L Ellis
- School of Aging Studies, University of South Florida, Tampa, Florida; Florida Policy Exchange Center on Aging, University of South Florida, Tampa, Florida
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Hazelhof TJGM, Gerritsen DL, Schoonhoven L, Koopmans RTCM. "The educating nursing staff effectively (TENSE) study": design of a cluster randomized controlled trial. BMC Nurs 2014; 13:46. [PMID: 25606022 PMCID: PMC4299299 DOI: 10.1186/s12912-014-0046-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 12/03/2014] [Indexed: 12/31/2022] Open
Abstract
Background Challenging behavior exhibited by people with dementia can have adverse outcomes, like stress, low morale, low work satisfaction and absenteeism for nursing staff in long-term care settings. Training nursing staff to manage challenging behavior may reduce its impact. Although much of the research into training nursing staff shows methodological limitations, several studies find some effect of training programs on knowledge about and on management of challenging behavior. Effects on stress or burnout are almost not found. Methods/Design The TENSE-study is a randomized controlled study on 18 nursing home units (9 control, 9 intervention) investigating the effects of a continuous educational program for nursing staff about managing challenging behavior. Nursing staff of intervention units receive the program, nursing staff of control units do not and continue usual care. The primary outcome is stress experienced by nursing staff (N = 135). Secondary outcomes are: emotional workload, work satisfaction, stress reactions at work and knowledge about challenging behaviour of nursing staff; and frequency of challenging behavior, quality of life and social engagement of residents (N = 135). Because there are many unknown factors influencing the effect of the training, a process evaluation to evaluate sampling-, implementation- and intervention quality as well as barriers and facilitators to implementation will also be included in the analysis. Nursing staff could not be blinded to the intervention, but were blinded for the outcomes. Discussion Strengths of this study are the (good) description of the intervention complemented by a process evaluation and the tailoring of the intervention to the wishes and needs of the nursing homes at any moment during the study. Sustaining the effects of the intervention by using follow up sessions is another strength. Possible drawbacks may be dropout because of the frailty of the elderly population and because nursing staff might move to another job during the study. Trial registration NTR (Dutch Trial Registration) number NTR3620
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Affiliation(s)
- Theo J G M Hazelhof
- Vitalis WoonZorggroep Eindhoven, Eindhoven, the Netherlands ; Department of Primary and Community Care: Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care: Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Lisette Schoonhoven
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, the Netherlands ; Faculty of Health Science, University of Southampton, Southampton, UK
| | - Raymond T C M Koopmans
- Department of Primary and Community Care: Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, the Netherlands ; Joachim en Anna, Centre for Specialized Geriatric Care, Nijmegen, the Netherlands
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Fossey J, Masson S, Stafford J, Lawrence V, Corbett A, Ballard C. The disconnect between evidence and practice: a systematic review of person-centred interventions and training manuals for care home staff working with people with dementia. Int J Geriatr Psychiatry 2014; 29:797-807. [PMID: 24535885 DOI: 10.1002/gps.4072] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 12/11/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The overall objective is to determine the availability of person-centred intervention and training manuals for dementia care staff with clinical trial evidence of efficacy. DESIGN Interventions were identified using a search of electronic databases, augmented by mainstream search engines, reference lists, hand searching for resources and consultation with an expert panel. The specific search for published manuals was complemented by a search for randomised control trials focussing on training and activity-based interventions for people with dementia in care homes. Manuals were screened for eligibility and rated to assess their quality, relevance and feasibility. RESULTS A meta-analysis of randomised control trials indicated that person-centred training interventions conferred significant benefit in improving agitation and reducing the use of antipsychotics. Each of the efficacious packages included a sustained period of joint working and supervision with a trained mental health professional in addition to an educational element. However, of the 170 manuals that were identified, 30 met the quality criteria and only four had been evaluated in clinical trials. CONCLUSIONS Despite the availability of a small number of evidence-based training manuals, there is a widespread use of person-centred intervention and training manuals that are not evidence-based. Clearer guidance is needed to ensure that commissioned training and interventions are based on robust evidence.
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Affiliation(s)
- Jane Fossey
- Psychological Services, Oxford Health NHS Foundation Trust, Oxford, UK
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Teresi JA, Ocepek-Welikson K, Ramirez M, Eimicke JP, Silver S, Van Haitsma K, Lachs MS, Pillemer KA. Development of an instrument to measure staff-reported resident-to-resident elder mistreatment (R-REM) using item response theory and other latent variable models. THE GERONTOLOGIST 2014; 54:460-72. [PMID: 23448960 PMCID: PMC4013722 DOI: 10.1093/geront/gnt001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 01/02/2013] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Although numerous studies have measured behaviors among individuals in congregate settings, few have focused on resident-to-resident elder mistreatment (R-REM). To our knowledge, there is no psychometrically developed measure of R-REM extant. The quantitative development of a measure of staff-reported R-REM is described. METHODS The design was a prevalent cohort study of residents of 5 long-term care facilities. The primary certified nursing assistant was interviewed about R-REM. Advanced measurement methods were used to develop a measure of R-REM. RESULTS The loadings on the general factor for the final 11-item scale were greater than those on the group factor except for the item "other physical behavior" (0.63 vs. 0.74), suggesting essential unidimensionality. Although the bifactor model fit was slightly better than that of the unidimensional model, the difference was trivial (bifactor comparative fit index [CFI] = 0.997, root mean square error of approximation [RMSEA] = 0.013, unidimensional CFI = 0.979, and RMSEA = 0.030). However, modest support was provided for use of verbal and physical subscales. The explained common variance statistics were 0.76 for the bifactor model compared with 0.63 for the unidimensional model. DISCUSSION The development of this R-REM measure will help to advance the measurement and ultimately evaluation of interventions associated with this important and under recognized problem facing residents in long-term care settings.
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Affiliation(s)
- Jeanne A Teresi
- Address correspondence to Mildred Ramirez, Research Division, Hebrew Home at Riverdale, 5901 Palisade Avenue, Riverdale, NY 10471. E-mail:
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Ellis JM, Teresi JA, Ramirez M, Silver S, Boratgis G, Kong J, Eimicke JP, Sukha G, Lachs MS, Pillemer KA. Managing resident-to-resident elder mistreatment in nursing homes: the SEARCH approach. J Contin Educ Nurs 2014; 45:112-21; quiz 122-3. [PMID: 24548656 PMCID: PMC4178932 DOI: 10.3928/00220124-20140223-01] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 11/27/2013] [Indexed: 11/20/2022]
Abstract
This article describes an educational program to inform nursing and care staff of the management of resident-to-resident elder mistreatment (R-REM) in nursing homes, using the SEARCH (Support, Evaluate, Act, Report, Care plan, and Help to avoid) approach. Although relatively little research has been conducted on this form of abuse, there is mounting interest in R-REM because such aggression has been found to be extensive and can have both physical and psychological consequences for residents and staff. The goal of the SEARCH approach is to support staff in the identification and recognition of R-REM as well as to suggest recommendations for management. The educational program and the SEARCH approach are described. Three case studies from the research project are presented, illustrating how nurses and care staff can use the SEARCH approach to manage R-REM in nursing homes. Resident and staff safety and well-being can be enhanced by the use of the evidence-based SEARCH approach.
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Quality assurance and performance improvement in nursing homes: using evidence-based protocols to observe nursing care processes in real time. J Nurs Care Qual 2013; 28:43-51. [PMID: 22902936 DOI: 10.1097/ncq.0b013e31826b090b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Quality Assurance and Performance Improvement Initiative, a component of the Affordable Care Act (2010), is a new approach to quality improvement for US nursing homes. The article describes components of the Quality Assurance and Performance Improvement Initiative, the unique contributions of registered nurses to its implementation, and data collection strategies using direct observation and evidence-based measures and protocols in a Quality Assurance and Performance Improvement program.
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State regulations for nursing home residents with serious mental illness. Community Ment Health J 2013; 49:389-95. [PMID: 22837103 DOI: 10.1007/s10597-012-9527-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 07/02/2012] [Indexed: 10/28/2022]
Abstract
To identify state regulations for nursing home residents with Serious Mental Illness (SMI). We reviewed state regulations for policies relating to nursing home residents with SMI, and conducted interviews with expert stakeholders. A framework for analyzing state regulations was generated by identifying four discrete categories: States with specific mental illness regulations, Alzheimer's or dementia regulations, minor mention of mental illness, and no mention of mental illness. A large majority of the states have little or no mention of mental illness in their nursing home regulations, suggesting limited attention to all forms of mental illness by most state regulatory bodies.
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Söderlund M, Norberg A, Hansebo G. Validation method training: nurses' experiences and ratings of work climate. Int J Older People Nurs 2013; 9:79-89. [PMID: 23601158 DOI: 10.1111/opn.12027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 02/03/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Training nursing staff in communication skills can impact on the quality of care for residents with dementia and contributes to nurses' job satisfaction. Changing attitudes and practices takes time and energy and can affect the entire nursing staff, not just the nurses directly involved in a training programme. Therefore, it seems important to study nurses' experiences of a training programme and any influence of the programme on work climate among the entire nursing staff. AIMS AND OBJECTIVES To explore nurses' experiences of a 1-year validation method training programme conducted in a nursing home for residents with dementia and to describe ratings of work climate before and after the programme. DESIGN A mixed-methods approach. METHODS Twelve nurses participated in the training and were interviewed afterwards. These individual interviews were tape-recorded and transcribed, then analysed using qualitative content analysis. The Creative Climate Questionnaire was administered before (n = 53) and after (n = 56) the programme to the entire nursing staff in the participating nursing home wards and analysed with descriptive statistics. RESULTS Analysis of the interviews resulted in four categories: being under extra strain, sharing experiences, improving confidence in care situations and feeling uncertain about continuing the validation method. The results of the questionnaire on work climate showed higher mean values in the assessment after the programme had ended. CONCLUSION The training strengthened the participating nurses in caring for residents with dementia, but posed an extra strain on them. These nurses also described an extra strain on the entire nursing staff that was not reflected in the results from the questionnaire. The work climate at the nursing home wards might have made it easier to conduct this extensive training programme. IMPLICATIONS FOR PRACTICE Training in the validation method could develop nurses' communication skills and improve their handling of complex care situations.
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Affiliation(s)
- Mona Söderlund
- Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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What is person-centred care in dementia? Clinical reviews into practice: the development of the VIPS practice model. ACTA ACUST UNITED AC 2013. [DOI: 10.1017/s0959259813000014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SummaryThe VIPS framework is a four-part definition of person-centred care for people with dementia (PCC), which arose out of an earlier review article for this journal. The definition has assisted in the practical application of person-centred care. It has been operationalized into the VIPS practice model (VPM), which has been subject to a recent randomized controlled trial within Norwegian nursing homes. The VPM provided a vehicle for the VIPS framework to be utilized during reflective practice meetings focusing on understanding care situations from the perspective of residents with moderate to severe dementia. VPM incorporated an education and coaching approach, clearly defined staff roles, and resident-focused outcomes in a cycle to support improvements in quality of care. The use of VPM in practice is discussed. VPM was built utilizing the literature from organizational change. The role of literature reviews in bringing about change in practice is highlighted.
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