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Heckman GA, Boscart VM, McKelvie RS. Management considerations in the care of elderly heart failure patients in long-term care facilities. Future Cardiol 2014; 10:563-77. [DOI: 10.2217/fca.14.35] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
ABSTRACT: Heart failure, a condition that affects up to 20% of older persons residing in long-term care facilities, is an important cause of morbidity, health service utilization and death. Effective and interprofessional heart failure care processes could potentially improve care, outcomes and quality of life and delay decline or hospital admission. This article reviews the clinical aspects of heart failure, and the challenges to the diagnosis and management of this condition in long-term care residents who are frail and are affected by multiple comorbidities.
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Affiliation(s)
- George A Heckman
- Research Institute on Aging, University of Waterloo, BMH 3734, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Veronique M Boscart
- Conestoga College, School for Health & Life Sciences & Community Services, 299 Doon Valley Drive, Kitchener, ON, N2G 4M4, Canada
| | - Robert S McKelvie
- McMaster University & Hamilton Health Sciences, David Braley Cardiac, Vascular & Stroke Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
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Tucker S, Wilberforce M, Brand C, Abendstern M, Challis D. All things to all people? The provision of outreach by community mental health teams for older people in England: findings from a national survey. Int J Geriatr Psychiatry 2014; 29:489-96. [PMID: 24123314 DOI: 10.1002/gps.4031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 08/13/2013] [Accepted: 09/06/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study is to identify the extent of outreach activity community mental health teams (CMHTs) for older people provide to mainstream services in light of the recommendations of the National Dementia Strategy. In particular, to determine the range of settings in receipt of support; to specify the form of this activity; to identify the professionals involved; and to explore the factors associated with the provision of such support. METHODS A self-administered postal questionnaire was sent to all CMHTs in England. The reported arrangements were categorised and reviewed according to a taxonomy of outreach developed from the literature. RESULTS Three hundred and seventy six (88%) of the CMHTs responded. Although nearly all teams undertook some outreach work, much of this was informal in nature. Nevertheless, the vast majority of teams had some formal outreach arrangements in at least one mainstream setting. Just less than three-quarters provided support (most typically education) to care homes, approaching half centres to day centres, and over a third to primary care practices, social services teams, home care providers and general hospitals, respectively. Link workers were the favoured means of supporting general hospital staff. Community mental health nurses were most commonly involved in providing outreach, and larger teams were more likely than smaller teams to have formalised arrangements. A significant minority of teams expressed concerns about their capacity to provide effective services. CONCLUSIONS The findings suggest that both more resources and more evidence will be needed to meet the National Dementia Strategy's aim of improving care for older people with mental health problems in mainstream settings.
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Affiliation(s)
- Sue Tucker
- Personal Social Services Research Unit, University of Manchester, Manchester, England, UK
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Taylor J, Sims J, Haines TP. The emergent relevance of care staff decision-making and situation awareness to mobility care in nursing homes: an ethnographic study. J Adv Nurs 2014; 70:2767-78. [PMID: 24735067 DOI: 10.1111/jan.12425] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Janice Taylor
- Faculty of Medicine, Nursing and Health Sciences; Monash University; Notting Hill Victoria Australia
| | - Jane Sims
- Faculty of Medicine, Nursing and Health Sciences; Monash University; Notting Hill Victoria Australia
| | - Terry P. Haines
- Allied Health Research Unit; Kingston Centre; Southern Health; Cheltenham Victoria Australia
- Southern Physiotherapy Clinical School; Monash University; Melbourne Victoria Australia
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Abstract
Care home medicine has been an under-researched area, but over the last decade there has been a substantial growth in publications. Most of these have focused on the 'geriatric giants' of falls, incontinence and mental health issues (especially dementia, behavioural disturbance and depression) as well as other key topics such as medication use and issues related to death and dying. Other areas of recent interest are around access to health services for care home residents, how such services may most effectively be developed and how the quality of life for residents can be enhanced. While many of the reported studies are small and not always well designed, evidence in several areas is emerging which begins to guide service developments. A common theme is that multi-disciplinary interventions are the most effective models of delivery. The role of care home staff as members of these teams is key to their effectiveness. Recent consensus guidelines around falls prevention in care homes synthesise the evidence and recommend multi-disciplinary interventions, and clarify the role of vitamin D and of exercise in certain populations in the care home. The benefits of pharmacist led medication reviews are beginning to emerge; although studies reviewed to date have not yet led to the 'holy grail' of hospital admission avoidance they point to benefits in reduction of drug burden. Effectiveness may be enhanced when working with GPs and care home nurses. Welcome evidence is emerging that in the UK the rate of prescription of anti-psychotics has fallen. This is clear evidence that changes in practice around care homes can be effected. The poor access to non-pharmacological therapies for care home residents with behavioural disturbance remains a significant gap in service. End-of-life care planning and delivery is an important part of care in care homes, and there is evidence that integrated pathways can improve care; however, the use of palliative care medications was limited unless specialist care staff were involved. Integrated models of care that focus on resident-centred goals and which value the role of care home staff as members of the team working to deliver these goals are most likely to result in improvements in the quality of care experienced by care home residents.
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Affiliation(s)
- Eileen Burns
- Department Medicine for the Elderly, St James's Hospital, Beckett St, Leeds LS9 7TF, UK
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Stone L, Kinley J, Hockley J. Advance care planning in care homes: the experience of staff, residents, and family members. Int J Palliat Nurs 2013; 19:550-7. [DOI: 10.12968/ijpn.2013.19.11.550] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Jo Hockley
- For Care Homes, Care Home Project Team, St Christopher's Hospice, 51–59 Lawrie Park Road, Sydenham, London, SE26 6DZ
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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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Marques A, Cruz J, Barbosa A, Figueiredo D, Sousa LX. Motor and multisensory care-based approach in dementia: long-term effects of a pilot study. Am J Alzheimers Dis Other Demen 2013; 28:24-34. [PMID: 23221028 PMCID: PMC10697233 DOI: 10.1177/1533317512466691] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examined the short-, mid-, and long-term effects of a motor and multisensory care-based approach on (i) the behavior of institutionalized residents with dementia and (ii) care practices according to staff perspective. In all, 6 residents with moderate to severe dementia (mean age 80.83 ± 10.87 years) and 6 staff members (40 ± 10.87 years old) were recruited. Motor and multisensory stimulation strategies were implemented in residents' morning care. Data were collected with video recordings and focus-group interviews before, immediately after, at 3 months and 6 months after the intervention. The frequency and duration of each resident's behavior were analyzed. Content analysis was also performed. Results showed short-term improvements in residents' communication and engagement, followed by a sustained decline over time. Staff reported to change their practices; however, difficulties related to the institution organization were identified. There is a need to implement long-term strategies and involve institutions at different organizational levels to sustain the results.
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Affiliation(s)
- Alda Marques
- School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal.
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Clarke N. Transfer of training: the missing link in training and the quality of adult social care. HEALTH & SOCIAL CARE IN THE COMMUNITY 2013; 21:15-25. [PMID: 22804952 DOI: 10.1111/j.1365-2524.2012.01082.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Recent UK social care reforms characterised by a policy of increasing personalisation and choice in adult social care have been accompanied by major reorganisation and investment in workforce training and development. There is an assumed link between training and the quality of care received. This assumption has a long pedigree in social care, but rarely does it receive the scrutiny necessary for us to understand better the nature of this relationship. This paper focuses on the potential for in-service training to contribute to the transformation in social care as expected by policy-makers. Reviewing recent findings from the evaluation of training in social care shows that problems continue to persist in demonstrating that training results in changes in practitioner behaviour back on the job. Findings within the social care literature mirror those found more widely in suggesting learner characteristics, intervention design, and delivery and the workplace environment combine to influence whether training transfers to use on the job. The argument advanced here is that without a focus on the transfer of training, the contribution of training to quality of care outcomes will remain illusory. A shift is required in policy-makers' mindsets away from training, to a focus on training transfer in directing workforce development strategies. It might then be possible to begin to identify how and in what configurations training may be associated with quality of care outcomes.
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Alnes RE, Kirkevold M, Skovdahl K. The influence of the learning climate on learning outcomes from Marte Meo counselling in dementia care. J Nurs Manag 2012; 21:130-40. [PMID: 23339503 DOI: 10.1111/j.1365-2834.2012.01436.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To identify factors that affected the learning outcomes from Marte Meo counselling (MMC). BACKGROUND Although MMC has shown promising results regarding learning outcomes for staff working in dementia-specific care units, the outcomes differ. METHOD Twelve individual interviews and four focus group interviews with staff who had participated in MMC were analysed through a qualitative content analysis. RESULTS The learning climate has considerable significance for the experienced benefit of MMC and indicate that this learning climate depends on three conditions: establishing a common understanding of the content and form of MMC, ensuring staff's willingness to participate and the opportunity to do so, and securing an arena in the unit for discussion and interactions. CONCLUSION Learning outcomes from MMC in dementia-specific care units appear to depend on the learning climate in the unit. Implication for nursing management The learning climate needs attention from the nursing management when establishing Marte Meo intervention in nursing homes. The learning climate can be facilitated through building common understandings in the units regarding why and how this intervention should take place, and by ensuring clarity in the relationship between the intervention and the organization's objectives.
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Affiliation(s)
- Rigmor Einang Alnes
- Department of Health Science, Aalesund University College, Aalesund, Norway.
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Mathie E, Goodman C, Crang C, Froggatt K, Iliffe S, Manthorpe J, Barclay S. An uncertain future: the unchanging views of care home residents about living and dying. Palliat Med 2012; 26:734-43. [PMID: 21697261 DOI: 10.1177/0269216311412233] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Older people living in a care home have a limited life expectancy, and care homes are an important setting for end-of-life care provision. AIM This research aimed to explore the views, experiences and expectations of end-of-life care among care home residents to understand if key events or living in a residential environment influenced their views. DESIGN The research used a prospective design. The paper draws on the qualitative interviews of 63 care home residents who were interviewed up to three times over a year. This was a sub-sample of the larger data set of 121 care home residents. SETTING/PARTICIPANTS The residents were recruited from six care homes (providing personal care with no on-site nursing) in the UK. RESULTS Four main themes were identified; Living in the Past, Living in the Present, Thinking about the Future and Actively Engaged with planning the future. Many residents said they had not spoken to the care staff about end-of-life care; many assumed their family or General Practitioner would take responsibility. CONCLUSIONS Core to the older person's ability to discuss end-of-life care is their acceptance of being in a care home, the involvement of family members in making decisions and the extent to which they believed they could influence decision making within their everyday lives. Advance care plans should document ongoing dialogue. These findings can inform how primary health and palliative care services introduce, discuss and tailor existing frameworks and programmes of end-of-life care.
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Brown Wilson C, Swarbrick C, Pilling M, Keady J. The senses in practice: enhancing the quality of care for residents with dementia in care homes. J Adv Nurs 2012; 69:77-90. [PMID: 22462405 DOI: 10.1111/j.1365-2648.2012.05992.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM The study aimed to develop, deliver, and evaluate a training programme in care homes to enhance the quality of care for people living with dementia based on the principles of relationship-centred care expressed through the Senses Framework. BACKGROUND There are increasing numbers of people living with dementia worldwide with a growing proportion requiring residential long-term care. This makes the quest for enhancing the quality of care and quality of life for people with dementia ever more pressing. DESIGN A mixed-methods design was used adopting a Practice Development approach. The findings from one care home in the North West of England are reported. METHODS Eight facilitated workshops based on the principles of relationship-centred care were completed and evaluated in 2010, using pre- and postintervention design. A focus group was undertaken with staff on completion of the study to gain a more comprehensive understanding of the practice/training context, augmented by case examples of changes in practice identified from the study workshops. RESULTS Structured questionnaires were used to profile the care home before and after the training. Following the workshops, staff felt more able to collect and use biographical information. In particular, staff reported how this information supported them to initiate meaningful conversations with the person with dementia as part of everyday care routines, thus improving overall feelings of well-being. CONCLUSION Using a biographical approach to care planning structured through the Senses Framework helped staff to develop a greater understanding of the person with dementia.
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62
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Koh LC. Student attitudes and educational support in caring for older people – A review of literature. Nurse Educ Pract 2012; 12:16-20. [DOI: 10.1016/j.nepr.2011.04.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 03/25/2011] [Accepted: 04/28/2011] [Indexed: 10/18/2022]
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Venturato L, Moyle W, Steel A. Exploring the gap between rhetoric and reality in dementia care in Australia: Could practice documents help bridge the great divide? DEMENTIA 2011; 12:251-67. [DOI: 10.1177/1471301211421837] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Quality of care, and indeed, quality of life, for people living with dementia in long-term care is often underpinned by philosophies of care, such as person-centred care and relationship-centred care. The translation of these philosophies into practice is influenced by a range of individual and organizational features, including the context in which such care occurs. Within modern care organizations, the context of care is evidenced through organizational documents. This study sought to identify the key documents guiding dementia care within one large Australian long-term care organization and to explore points of consistency and tension within the documented system of care. Results highlight a lack of consistency and clarity in the philosophy of dementia care and a disconnection between the key documents guiding practice. This disconnection creates tension for clinicians and carers, and may contribute to the gap between rhetoric and reality in dementia care. This study suggests that a congruent documented dementia system can help bridge the gap between espoused philosophies of care and everyday care practices.
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Affiliation(s)
| | - Wendy Moyle
- Griffith University, Australia
- RSL Care, Queensland, Australia
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64
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Development and evaluation of an educational intervention for general practitioners and staff caring for people with dementia living in residential facilities. Int Psychogeriatr 2011; 23:221-9. [PMID: 20950507 DOI: 10.1017/s104161021000195x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Despite high levels of participation in dementia education, general practitioners (GPs) and residential care facility (RCF) staff report perceived learning needs. Small group education, which is flexible, individualized, practical and case-based, is sought. We aimed to develop educational interventions for GPs and RCF staff tailored to meet their perceived educational needs. METHODS We used a consultative process to develop education programs. A flexible program for RCF staff was developed in 30-minute blocks, which could be combined in sessions of different lengths. The RCF program aimed to facilitate sustainable change by engaging local "Dementia Champions". For GPs, face-to-face and self-directed packages were developed. We collected participant feedback to evaluate the program. RESULTS GPs and RCF staff were recruited as part of a larger intervention study. Sixteen of the 27 GPs who were offered the dementia education participated. Two of the 16 GPs participated in both learning packages. A total of 45 GP feedback responses were received from 16 GPs: 28 out of 45 GPs (62%) reported that the participants' learning needs were entirely met. Eighteen of 19 facilities offered the intervention participated and 326 RCF staff attended one or more of the 94 RCF education sessions. Feedback was collected from 93 sessions: 1013 out of 1067 RCF staff feedback responses (95%) reported that the session met the participants' learning needs. Qualitative feedback was also strongly positive. CONCLUSION Participants perceived the education programs as meeting their needs. Despite explicit attempts to provide flexible delivery options, overall participation rates remained low.
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Recommendations for staff education and training for older people with mental illness in long-term aged care. Int Psychogeriatr 2010; 22:1097-106. [PMID: 20843396 DOI: 10.1017/s1041610210001754] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This paper was written as a result of the International Psychogeriatric Association Task Force on Mental Health Services in Long-Term Care. The appraisal presented here aims to (1) identify the best available evidence that underpins best practice for geriatric mental health education and training of staff working in long-term care, and (2) summarize the appraisal of the literature to provide recommendations for practice. METHODS An initial search of databases found 138 papers related to the search strategy. Selected papers were summarized and compared against set inclusion criteria. This resulted in 17 papers suitable for review. RESULTS The majority of papers focused on behavior skills training. A number of key factors were identified that determine the success of geriatric mental health education and training and recommendations are outlined. CONCLUSIONS Methodological weaknesses are common and highlight the need for further replication studies using strong research designs.
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Moyle W, Borbasi S, Wallis M, Olorenshaw R, Gracia N. Acute care management of older people with dementia: a qualitative perspective. J Clin Nurs 2010; 20:420-8. [PMID: 21029231 DOI: 10.1111/j.1365-2702.2010.03521.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM AND OBJECTIVES This Australian study explored management for older people with dementia in an acute hospital setting. BACKGROUND As the population ages, increasing numbers of older people with dementia are placed into an acute care hospital to manage a condition other than dementia. These people require special care that takes into account the unique needs of confused older people. Current nursing and medical literature provides some direction in relation to best practice management; however, few studies have examined this management from the perspective of hospital staff. DESIGN A descriptive qualitative approach was used. METHOD Data were collected using semi-structured audio-taped interviews with a cross section of thirteen staff that worked in acute medical or surgical wards in a large South East Queensland, Australia Hospital. RESULTS Analysis of data revealed five subthemes with the overarching theme being paradoxical care, in that an inconsistent approach to care emphasised safety at the expense of well-being and dignity. A risk management approach was used rather than one that incorporated injury prevention as one facet of an overall strategy. CONCLUSION Using untrained staff to sit and observe people with dementia as a risk management strategy does not encourage an evidence-based approach. Staff education and environmental resources may improve the current situation so that people with dementia receive care that takes into account their individual needs and human dignity. RELEVANCE TO CLINICAL PRACTICE Nurses can assist older people with dementia by encouraging evidence-based care practices to become the part of hospital policy.
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Affiliation(s)
- Wendy Moyle
- Authors: Griffith Health Institute, Griffith University, Nathan Campus, Brisbane, Queensland, Australia.
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67
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Helgesen AK, Larsson M, Athlin E. ‘Patient participation’ in everyday activities in special care units for persons with dementia in Norwegian nursing homes. Int J Older People Nurs 2010; 5:169-78. [DOI: 10.1111/j.1748-3743.2010.00223.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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68
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Affiliation(s)
- Kerri Wright
- Department of Acute and Continuing Care, University of Greenwich, London
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69
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Kelly M, McSweeney E. Re‐visioning respite: a culture change initiative in a long‐term care setting in Eire. QUALITY IN AGEING AND OLDER ADULTS 2009. [DOI: 10.1108/14717794200900020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Beer C, Horner B, Almeida OP, Scherer S, Lautenschlager NT, Bretland N, Flett P, Schaper F, Flicker L. Current experiences and educational preferences of general practitioners and staff caring for people with dementia living in residential facilities. BMC Geriatr 2009; 9:36. [PMID: 19674462 PMCID: PMC2733895 DOI: 10.1186/1471-2318-9-36] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 08/12/2009] [Indexed: 11/20/2022] Open
Abstract
Background Residential care is important for older adults, particularly for those with advanced dementia and their families. Education interventions that achieve sustainable improvement in the care of older adults are critical to quality care. There are few systematic data available regarding the educational needs of Residential Care Facility (RCF) staff and General Practitioners (GPs) relating to dementia, or the sustainability of educational interventions. We sought to determine participation in dementia education, perceived levels of current knowledge regarding dementia, perceived unmet educational needs, current barriers, facilitators and preferences for dementia education. Methods A mixed methods study design was utilised. A survey was distributed to a convenience sample of general practitioners, and staff in 223 consecutive residential care facilities in Perth, Western Australia. Responses were received from 102 RCF staff working in 10 facilities (out of 33 facilities who agreed to distribute the survey) and 202 GPs (19% of metropolitan GPs). Quantitative survey data were summarised descriptively and chi squared statistics were used to analyse the distribution of categorical variables. Qualitative data were collected from general practitioners, staff in residential care facilities and family carers of people with dementia utilizing individual interviews, surveys and focus groups. Qualitative data were analysed thematically. Results Among RCF staff and GPs attending RCF, participation in dementia education was high, and knowledge levels generally perceived as good. The individual experiences and needs of people with dementia and their families were emphasised. Participants identified the need for a person centred philosophy to underpin educational interventions. Limited time was a frequently mentioned barrier, especially in relation to attending dementia care education. Perceived educational needs relating to behaviours of concern, communication, knowledge regarding dementia, aspects of person centred care, system factors and the multidisciplinary team were consistently and frequently cited. Small group education which is flexible, individualized, practical and case based was sought. Conclusion The effectiveness and sustainability of an educational intervention based on these findings needs to be tested. In addition, future interventions should focus on supporting cultural change to facilitate sustainable improvements in care.
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Affiliation(s)
- Christopher Beer
- Western Australian Centre for Health & Ageing, Western Australian Institute for Medical Research, Perth, Australia.
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